Why have fentanyl deaths and seizures climbed so steeply (540%) in the last three years? Fentanyl is now the number one cause of drug overdoses in the US.

What are Fentanyls

~100 times a more potent analgesic than morphine (1) and ~40 times more so than heroin, Fentanyl is a powerful opioid used for pain treatment, first in the 1990s as a patch and now as a spray. An example of its potency, David Juurlink an opioid researcher at the University of Toronto says he'd give a hospital patient 10mg of morphine but only 0.1mg of fentanyl (2).

Widely considered too dangerous for humans, carefentanil is fentanyl's much more potent analog (similar chemical structure) and used as an elephant tranquilizer. So potent is carfentanil some countries including the US have even considered its use as a chemical weapon in war (3).

Fentanyls are so dangerous in overdoses because they can even negate Naloxone - Wikipedia, which is usually used to reverse heroin overdoses.

For example, where typically just one naloxone dose can reverse painkiller or heroin overdose, fentanyl overdose requires several naloxone doses. This is because of fentanyl's much higher affinity for the mu opioid receptor in the brain, which it accesses much more easily than morphine or heroin, given its much higher fat solubility (4).

Fentanyls can be so deadly (see photo below from 4), first responders need to be trained to protect themselves from accidental overdoses themselves (5).

Why Fentanyls have become a new front in the current US opioid crisis

Recent steep climbs in US fentanyl overdose deaths and seizures personify the Balloon effect - Wikipedia (2). How to optimally deal with drug abuse? Need strategies to deal with both supply and demand.

US history shows it tends to crack down hard on the supply side while doing little to tamp down demand. Arguably, tamping down hard on the supply side would reduce future demand but what happens to current demand if it isn't a priority of drug control policy? Just as air in a half-inflated balloon moves to another part of the balloon when it's pressed, when supply's squeezed without equivalent effort to reduce demand, users and traffickers figure out other means for getting high (2).

How opioid demand was created. Starting in the late 1990s, US doctors began handing out opioids like candy. Apparently both they and the FDA were taken in by opioid manufacturers' false claims these opioids weren't addictive. This practice both created and nurtured the growth for opioid demand. Supply wasn't a problem either for many years. However, starting in the early 2010s, people started dying in unprecedented numbers from opioid abuse overdose. Law enforcement started cracking down on prescribing doctors and pill mills, though interestingly not the pharmas making these opioids. As supply started drying up, users and traffickers diversified, first to heroin then to heroin laced with fentanyls.

Rationale for fentanyls. Given its easy access, drug traffickers started adding fentanyl to heroin to juice it up. Economic argument for fentanyl made itself. Fentanyl and carfentanil are just two of many fentanyls, all relatively easy to make in a lab, a far more simpler and cheaper approach than growing the opium poppy plant, extracting from it morphine and converting that to heroin. They also give a better and cheaper high than even heroin. Dealers can make more money from fentanyl-laced heroin (2). Dealers add fentanyl of questionable purity to the heroin they sell using scales and balances of questionable accuracy (3). Problem is users are unaware when their heroin is laced with fentanyl so injecting a usual heroin dose can lead to fentanyl overdose. The ensuing tragedy writes itself.

How opioid supply keeps creating new products to stay ahead of crackdowns. US law enforcement believes most fentanyl comes from labs in China (3), easily made there in bulk quantities without US regulatory or law enforcement supervision and then shipped into US via Latin America. On March 1, 2017, China banned manufacture and sale of fentanyl and some of its analogs including carfentanil (6), adding more analogs to the ban a couple of months later (7), making restrictions on a total of 138 compounds. However, chemists keep coming up with newer fentanyl analogs (see below from 6), making their control by regulators and law enforcement a case of Whac-A-Mole - Wikipedia.

Bibliography

1. https://www.deadiversion.usdoj.g...

2. Vox, German Lopez, May 16, 2017. How an elephant tranquilizer became the latest deadly drug in the opioid epidemic

3. Associated Press, Erika Kinetz, Desmond Butler, October 1, 2016. Chemical weapon for sale: China's unregulated narcotic

4. STAT news, Allison Bond, September 29, 2016. Why fentanyl is deadlier than heroin, in a single photo

5. The Atlantic, Sarah Zhang, May 15, 2017. Fentanyl Is So Deadly That It's Changing How First Responders Do Their Jobs

6. Science, Kathleen McLaughlin, March 29, 2017. Underground labs in China are devising potent new opiates faster than authorities can respond

7. Associated Press, June 19, 2017. China bans more synthetic opioids blamed for U.S. drug deaths

https://www.quora.com/Why-have-fentanyl-deaths-and-seizures-climbed-so-steeply-540-in-the-last-three-years-Fentanyl-is-now-the-number-one-cause-of-drug-overdoses-in-the-US/answer/Tirumalai-Kamala

Is India's perception of the caste system similar to America's perception of racism?

Dissimilarities between perceptions of caste system among Indians & of racism among Americans

My experience suggests perceptions of the caste system among Indians and of racism among Americans have two key differences, one of degree and the other of kind.

The one of degree is longevity. Thousands of years older, India's caste system has had that much more time to get thoroughly marinated in people's psyche. Inequities that should rightfully horrify any decent mind have thus become part of daily life, meaning people display a shocking degree of acceptance about the whole kit and caboodle of caste. Such wholesale acceptance of structural inequities is somewhat less visible except to discerning eyes in the frantic churn of huge, bustling metros, but much more so going down to smaller towns, becoming especially visible in the hamlets and villages of rural India.

The one of kind is the diabolically clever manner by which the Indian caste system was kept in place through history, by ascribing actions of the past life, one's past life's karmas, as the arbiter for present life caste.

‘Born low caste or worse yet, casteless Dalit in this life? Too bad, only means you committed awful sins in your past life so you're fated in this one to beg, be a cobbler, dispose of dead bodies or clean other people's toilets.

Born a high caste in this life? Excellent, earning it by your past life good deeds, you merit all the advantages bestowed upon you in this life by the mere accident of birth.’

The Indian caste system evolved to maintain social order by distributing power hierarchically and hereditarily. Its in-built advantage was a permanent and permanently oppressed under-class of casteless Dalits serving as the pressure release valve to mitigate inherent power distribution differences among caste Hindus. As for the Dalits? Conveniently self-serving answer in the form of 'Too bad, they're fated to carry in this life the burden of their past life karma'. Maintaining such a spurious charade for so long took a seriously devious level of con-artistry. After all, one can't petition for better equity in this life by summoning one's past life in court to provide evidence under oath of past life virtues, can one?

Similarities between perceptions of caste system among Indians & of racism among Americans

Segregation. Both American racism and Indian casteism malevolently twist the notions of purity and pollution to foster and maintain untenable levels of structural social and cultural inequity. Forceful black segregation followed by white self-segregation to affluent neighborhoods and better endowed school systems are eerily similar to how Dalits were kept segregated in India.

‘No, not among us, your community needs to live leeward down where the effluents flow out to from our pure caste habitations and no, you aren't welcome in our temples either. Stay away from us, you dushtas! Even your shadow must not cross us.’

What could breed more easily than suspicion and mistrust when population segments are kept or keep themselves separate? That makes it easier to filter and dole out privileges based on caste or race. After all, there's no law that a black man caught with marijuana should spend years in jail while a similarly culpable white man either pays a small fine or goes free. One can have any number of laws on the books but selective interpretation and application, which can be sub-conscious and therefore that much harder to pin down, thus end up actively shaping common perceptions, the easiest among them making a self-fulfilling prophecy out of the demonizing trope of excessive criminality among blacks.

Denial. American racism and Indian casteism also have in my opinion similar degree and vehemence in hand-waving away benefits one accrues from accident of birth. Both have instituted various forms of welfare subsidies and affirmative action programs as attempts to expiate past inequities, eliciting immediate incessant howls of 'foul, foul, unfair' from some of the generationally privileged. Why? Apparently life is zero-sum. Government attempts to tilt the scale away from generational inequity to benefit one apparently do so at the expense of another, who as a result is directly deprived.

As these efforts visibly benefit their poorest, Dalits in India and blacks in America, recriminations against them are usually barely restrained and easily provoked into full bloom. For example in America, Ronald Reagan needed but one example, that of career grifter Linda Taylor - Wikipedia, to excoriate legions of welfare recipients as Cadillac-driving welfare cheats and use as an excuse to start gutting the American social welfare system, a process that each successive administration has only added to to different degrees but not reversed, at least not substantially until the ACA Medicaid expansions.

Growing up in India, the arguments against affirmative action were variations of, 'What do you mean? I was born dirt poor and look how successful I've been. I'm a self-made person. I didn't depend on government hand-outs.'. At least materially, those who spoke thus were indeed born relatively poor and ended up firmly within the ranks of the relatively affluent middle-class. So what benefits were they hand-waving away?

How about a long lineage of literacy? Literacy is a priceless advantage, a generational privilege so easily taken for granted, it can be and indeed is entirely glossed over. Everyone in my family could read and write, even my great grandmother. Even today how many middle-aged Indians could claim even their great grandparents were literate? When I started to learn to read and write, I had not just access to all the necessary materials but indeed birth advantage meant just about everyone in my formative environment was able to help me along every step of the way.

Mind you, even those within my circle who grew up poor and claimed to be self-made somehow managed to attain multi-lingual fluency, being fluent in not just several Indian languages but also English, clear evidence if such were even necessary that even the so-called dirt poor aren't homogenous, with some endowed by caste (or race in America) with structural advantages of support networks and connections that rote political discourses choose to conveniently overlook.

Resentment. Another standard trope common to Indian casteism and American racism is the lowering of so-called standards and norms. Well, maybe the first few generations of literates among the generationally fettered would fluently deploy better vocabulary, syntax, grammar and spelling if they'd also been so lucky as to have their formative environment be staffed and stuffed with those capable of helping them every step of the way day in, day out but they just didn't.

For the most part, in both India and America they've merely had difficult and unstable access to poor schools in poor neighborhoods, staffed by poorly paid, poorly trained and likely poorly motivated teachers, access to few or none after-school resources, and certainly little access to knowledge and learning within their own families, communities and neighborhoods, not from any lack of moral fiber but simply as the reality of how structural social and cultural inequity plays out.

Rather than individual merit alone, intergenerational wealth and resource transfer greatly influence one's own success in life. Disproportionate numbers among Indian Dalits and American Blacks lack the resources to help finance their children's college education, help them make down payments on their houses or leave behind a bequest or inheritance, advantages the rest take for granted, and which help them both build and retain wealth across generations.

However, admitting such essential truths means letting the proverbial cat out of the bag, that such inequities exist not by accident but on purpose, to keep a permanent underclass of cheap and desperate labor available at the ready to do the bidding of the rest of society comprised of relative winners by birth. In that respect, not just perception but also purpose of caste in India and of racism in America are entirely yoked.

https://www.quora.com/Is-Indias-perception-of-the-caste-system-similar-to-Americas-perception-of-racism/answer/Tirumalai-Kamala

I am an Indian in US. I want my kid to become a doctor but he shows undue interest in arts. Initially it was just scribbling but now it’s like IT. How do I discourage my 6 year old kid from arts, paintings, and dinosaurs?

Someone who plans ahead to such an extent may find it well worth their while to mull through to the end possible outcomes from forcing a child away from art and into a medical school without regard to the child's wish. Let's consider a few such plausible future scenarios.

Scenario 1

Whoo! Glad to be done with the day. Great to lean back and enjoy some of this fine scotch. What's that? Yet another poor report card from Sanjeev? Apparently he's been lollygagging again, even after we confiscated all his art supplies. Honestly, I just don't know what to do about this boy. I'm at my wit's end. Why can't he appreciate how fortunate he is? I too was miserable at his age. Wanted to do nothing but play with paints and brushes. Look at me now. I hunkered down, gritted my way through medical school even though I hated every minute of it. That's what it takes to be a man, make the best of a bad situation and become responsible. Would he have so many advantages without all my sacrifice? Ungrateful little sniffler. Why should he get his own way when I couldn't? He's going to have to learn to be miserable just like me and roll with the punches. If I could do it, so can he.

Scenario 2

Dead at 28. How could I have known he was so miserable? Relatives buzzing around and yet everyone's so careful to keep their distance from me. Obviously too scared to ask why. Why did he jump? Why didn't he come to me if he was so miserable? Why did I do it? Why did I push him into medical school when he was just so miserable about it? All those times of 'Dad, can I...no, nothing, it's nothing'. It was all right there in front of me, his misery but I just didn't want to see it.

Scenario 3

Look at me. I look 50+ and I'm not even 40 yet. Wife walks by, yelling at me to take my feet off the coffee table. So what's new? Nag, nag, nag, can this woman even do anything else? Why is she even my wife? Ah, yes, dad, did everything dad told me to do including marry this woman and I can't even stand her. What? Now I can't even drink in my own house? I'll do as I damn well please in my own house. It's my house, dammit, paid for with my sweat and blood. Literal blood in the hospital. Hate the sight of blood, heh, and I'm a doctor. Ah, that sure hits the spot. Best medicine to take the edge off of her infernal nagging and that miserable hospital. Hate hospitals and oh, how I hate the patients, smelly, complaining, always complaining. Why did I even become a doctor? Dad again.

Nag's back. Sister's on the phone. Apparently it's about dad. Don't know why she went to visit him in the nursing home. Says something about bed sores. Thinks they're neglecting him. What the hell do I care about his effing bed sores? They can neglect him to death as far as I'm concerned. My life's a misery and he's to blame for all of it. Depressing old tyrant, he can rot in that nursing home for all I care. Ah, the latest brochure from the Museum of ***. Have been looking forward to their fall exhibition. Let's see, mmm...

Though being a considerate parent who doesn't force their agenda onto their children is no guarantee a child wouldn't grow up resentful and uncaring anyway, the men in these scenarios seem bitter or anguished, even contemptible, with no mystery as to how they got that way.

Why choose to inflict misery? And that's what a parent does when they force their kid to become a doctor or anything else regardless of what they themselves want. Such parents should then also wholeheartedly accept the outcome however that might play itself out, whether that means their children simply learn to perpetuate that misery by foisting it onto the next hapless generation or take drastic actions to end their misery or the parents themselves are neglected in old age by their children, three all too plausible scenarios. As the saying goes, misery loves company.

https://www.quora.com/I-am-an-Indian-in-US-I-want-my-kid-to-become-a-doctor-but-he-shows-undue-interest-in-arts-Initially-it-was-just-scribbling-but-now-it%E2%80%99s-like-IT-How-do-I-discourage-my-6-year-old-kid-from-arts-paintings-and-dinosaurs/answer/Tirumalai-Kamala

There are two types of men in this world… What are they?

A renowned psychologist, Viktor Frankl - Wikipedia was the founder of Logotherapy - Wikipedia, a theory of psychology that holds that a person's primary motivation is to find meaning in life.

Frankl developed his theory during his years in a series of Nazi concentration camps. In his acclaimed memoir of this period, Man's Search for Meaning - Wikipedia, Frankl pretty much settled the question about the two types of men, two types of humans really, decent and indecent (see below from Man's Search for Meaning. Viktor E. Frankl, 1946, emphasis mine). ‘Pretty much settled’ because life experience in general seems to bear out the essential truth as Frankl perceived it, albeit most of the rest of us are much more fortunate and never experience such hellish, exigent circumstances.

Human kindness can be found in all groups, even those which as a whole it would be easy to condemn. The boundaries between groups overlapped and we must not try to simplify matters by saying that these men were angels and those were devils. Certainly, it was a considerable achievement for a guard or foreman to be kind to the prisoners in spite of all the camp's influences, and, on the other hand, the baseness of a prisoner who treated his own companions badly was exceptionally contemptible. Obviously the prisoners found the lack of character in such men especially upsetting, while they were profoundly moved by the smallest kindness received from any of the guards. I remember how one day a foreman secretly gave me a piece of bread which I knew he must have saved from his breakfast ration. It was far more than the small piece of bread which moved me to tears at that time. It was the human "something" which this man also gave to me - the word and look which accompanied the gift.

From all this we may learn that there are two races of men in this world, but only these two - the "race" of the decent man and the "race" of the indecent man. Both are found everywhere; they penetrate into all groups of society. No group consists entirely of decent or indecent people.

https://www.quora.com/There-are-two-types-of-men-in-this-world-What-are-they/answer/Tirumalai-Kamala

How true is it that according to Ray Kurzweil, we are reaching a point where sickness & disease are all conquerable?

Are we 'reaching a point where sickness and disease are all conquerable’, apparently according to a 2005 book? A notion grounded in reality or one that exists in the fantasy landscape inhabited by those in positions of enormous wealth and influence? I'm particularly stuck by the yawning, obscene contrast between the techno-utopia implied by this question and manifest reality. Some absurd propositions just beg to be introduced violently to the reality on planet Earth.

The example of Remote Area Medical - Wikipedia (RAM) helps puncture the brazenly clueless notion that human sickness and disease are anywhere close to being 'conquered'. Started by Stan Brock (philanthropist) - Wikipedia in 1985, RAM provides a variety of healthcare services to needy people in remote parts of the world.

Needy people in remote parts. Maybe people in earthquake-hit parts of so-called Third World countries like Haiti? Rather, the bulk of RAM's services are provided in the US. Not remote parts of the US mind unless somehow places like Inglewood, CA, Seattle, WA, Knoxville and Memphis, both in TN, and Las Vegas, NV, (see examples below) are remote in which case the word's patently become meaningless.

So, in the year 2017, affordable healthcare is still so much out of reach for so many millions in the US that thousands of Americans wait for hours, even overnight, to get really free medical, dental and vision care at huge RAM clinics organized in enormous stadiums to accommodate the huge numbers in need (see below from remote area medical Archives - Insurance Thought Leadership and The Atlantic, Olga Khazan, January 22, 2015. Life in the Sickest Town in America).

If so many people in arguably the most powerful and wealthiest country in the world, in fact its sole current superpower, can't even access basic healthcare, how likely is it that we are even remotely close to a time when sickness and disease are all conquerable?

To conquer sickness and disease, shouldn't their diagnosis be a given in any and all circumstance in the first place, and if even that's not guaranteed in the US of all places, what chances it's universally available and affordable elsewhere? And of course, these are times when guarantee of life itself doesn't even exist in conflict-ridden places like Syria, Iraq, Democratic Republic of Congo and so many other places, a time when unprecedented numbers of people have recently joined the ranks of refugees. Let's park this techno-utopia where it truly belongs, in the realm of fantasy...unless we accept as reality the future depicted by sci-fi movies like Elysium (film) - Wikipedia.

Sources for further reading:

The Atlantic, Olga Khazan, January 22, 2015. Life in the Sickest Town in America

The Guardian, Amy Woolard, November 23, 2016. The enormous pop-up clinic trying to bridge America’s health divide | Amy Woolard

The Guardian, Jessika Bohon, June 12, 2017. Rural Appalachia is facing a healthcare crisis. I fear it's going to get much worse | Jessika Bohon

Ray Kurzweil, 2005. The Singularity Is Near - Wikipedia

https://www.quora.com/How-true-is-it-that-according-to-Ray-Kurzweil-we-are-reaching-a-point-where-sickness-disease-are-all-conquerable/answer/Tirumalai-Kamala

What are some examples of “intentional” bad design?

Termed 'defensive' or Hostile architecture - Wikipedia, a cornucopia of 'intentional' unpleasant design abounds all around us, especially in affluent urban centers. Examples of unpleasant design (see below from 1, 2, 3, 4, 5, 6) conspicuously shape public spaces to placate haves at the expense of have-nots, i.e., their aim ‘isn’t to achieve something good, like a safety goal’, but rather to keep certain people out.

Crudely executed ones such as the London Spikes (7) puncture the carefully constructed facade of how we engender consensus around the idea of what's publicly acceptable, which usually entails some form of hostility to the homeless.

Predictably of short duration, such outcries are responses to how public space is shaped, not about why it's being done in the first place. They also deflect attention from the core issue of how complicity is inherent to public consensus, how public policy usually assuages the wants of the haves at the expense of the needs of the have-nots.

Plenty more global examples of defensive architecture by Nils Norman - Wikipedia on his web-site (6).

Bibliography

1. Slate, Kristin Hohenadel, June 12, 2014. Are Anti-Homeless Sidewalk Spikes Immoral?

2. Guardian, Ben Quinn, June 13, 2014. Anti-homeless spikes are part of a wider phenomenon of 'hostile architecture'

3. Fagstein, June 13, 2014. “Homeless spikes” are gone — but what about Montreal’s other homeless deterrents?

4. The Atlantic, Robert Rosenberger, June 19, 2014. How Cities Use Design to Drive Homeless People Away

5. Guardian, Alex Andreou, February 18, 2015. Defensive architecture: keeping poverty unseen and deflecting our guilt

6. Archives | Dismal Garden

7. Petty, James. International Journal for Crime, Justice, and Social Democracy 5.1 (2016): 67-81. The London Spikes Controversy: Homelessness, Urban Securitisation and the Question of ‘Hostile Architecture’

https://www.quora.com/What-are-some-examples-of-%E2%80%9Cintentional%E2%80%9D-bad-design/answer/Tirumalai-Kamala

Can we genetically modify animals to procure organs for humans?

Why the need to use animal organs for human transplants? Is there even such a need? No, rather it's a technological solution proposed for an urgent but non-scientific supply and demand problem, namely, shortage of organs. More people die on waiting lists than receive transplants. This fait accompli is apparently all that's necessary to breathe life into the need for Xenotransplantation - Wikipedia, i.e., animal organ transplant into humans. However, accepting this fait accompli at face value is not only dangerous but also quite disingenuous for the following reasons.

Why Xenotransplantation Isn't An Appropriate Response To The Organ Crisis: It Doesn't Address The Underlying Issue

Transplant waiting lists keep growing. Not too few donors. Rather too many potential recipients. While donations and transplants remain steady, numbers waiting for transplants grow year-on-year (1) in developed countries. Scenario is palpably ghastlier in poorer countries, where forget transplants, even dialysis is usually beyond reach for many organ failure patients.

Why is the need for transplants increasing though? This is typically swept under the carpet as increasing morbidity rates. But why are morbidity rates increasing in the first place, especially in developed countries? Somehow this, the very crux of the matter, gets short shrift in both the biomedical literature and popular media.

~80% of those on waiting lists need kidneys due to ESRD (end-stage renal disease, Chronic kidney disease - Wikipedia). Increasing numbers of organ failure patients have ESLD (end-stage liver disease) (2). Most common predisposing factors are alcoholic liver cirrhosis (3), diabetes (4) and obesity (5). Clearly lifestyle issues drive need for more transplants. That is not to imply all transplants are for lifestyle-mediated chronic diseases but rather that much of the annual increase is driven by such preventable increases in morbidity.

Bad diets and sedentary lifestyles are apparently impossible to change as are the underlying socioeconomic structure and accompanying culture that increasingly make these the norm the world over. In other words, preventable, consumption-driven practices that predispose to transplant-requiring chronic health conditions have been allowed to seed and settle into society, no questions asked. Let's state the obvious. Where's the profit in prevention? Changing the culture, especially diet and lifestyle, is hard work, and even less appetizing for those habituated to feeding on the profits to be made from chronic diseases.

Thus, once such preventable diseases have taken root, capital intensive high-tech solutions to treat them including even xenotransplants become all the rage. Few mention that the organ crisis is nothing new, having existed since at least the 1980s (6). Evidently a case of the tail wagging the dog, the prevailing hegemony is thus to hardly ever allude in the first place to why need for organs is increasing and how to reduce it but rather to bemoan the organ crisis and contrive ever more creative and ethically challenging ways to increase the organ pool.

These creative though ethically challenging solutions started with expanding the definition of appropriate transplant sources. Originally, only deceased donations were allowed. Then definition of death expanded to include the legal fiction of two types of death, circulatory death (traditionally used) and brain death (7) so organs could be harvested from more bodies. Obviously brain death 'decriminalizes the harvesting of beating hearts' (8). Then donations from the living got the nod. Any surprise organ trafficking and global black market in organs followed suit (9), especially among the multitude too poor to feed themselves or their children (10, 11, 12)? After all their bodies are all they can offer the market.

Some European countries such as Greece and Spain have even taken the creative urge to extremes, embracing the currently fashionable Nudge theory - Wikipedia by introducing opt-out consent (13), where people are automatically presumed to have given consent to post-death organ donations unless they specifically take the trouble to opt-out while they're still alive. Supposed rationale is we humans are well-intentioned but lazy. Well-intentioned as in of course, we intend to choose to donate our organs after death but somehow we're too lazy to ever get around to giving the necessary legal heft, i.e., consent, to our good intentions.

And of course, desperation increasingly permeates the medico-legal culture which now explores using even infected (14) and mismatched kidney transplants (15). Meantime, the ongoing US drug overdose epidemic provides a ghastly book-end to the organ crisis by increasing organ availability (16).

Why Xenotransplantation Isn't A Solution To The Organ Crisis: Immunological Rejection & Infectious Disease Risk

And so we arrive at xenotransplantations, a path to unlimited supply of donors and their organs at least in theory. After all, what other purpose for this planet and its various denizens but to serve the human's needs. Unfortunately for the human, in this instance biology has turned out to be a more intractable partner.

• Immunological rejection remains a vexing issue decades into the project with little sign of improvement (17) but that's not the only concern.
• SARS (Severe acute respiratory syndrome - Wikipedia) in 2003, Bird flu (Influenza A virus subtype H5N1 - Wikipedia) in 2007, Swine flu (2009 flu pandemic - Wikipedia) in 2009, MERS (Middle East respiratory syndrome - Wikipedia) in 2012, Ebola virus disease - Wikipedia in 2014 and Zika fever - Wikipedia in 2015, these are major infectious disease outbreaks since just the mid-2000s, many of them Zoonosis - Wikipedia, jumps from animals to humans. Obviously then known and even as yet undiscovered viruses being transmitted from the animal donors to organ recipients remains an ever-present danger (18). Yes, a high-powered group led by Harvard geneticist George Church used CRISPR-cas9 (CRISPR - Wikipedia) to delete potentially harmful DNA sequences at 62 sites in pig cells (19) but that was just a preliminary proof of principle study. Do we really need to concoct yet another path for more pathogens to jump species and thrive in humans, which may well turn out to be the risk with Xenotransplantation?

In other words, technocracy encourages solutionism rather than trying to understand the fundamental crux of the problem, which in this case is spiraling rates of lifestyle-driven chronic diseases. Reducing them would automatically reduce the need for transplants in the first place (see below from 20, emphasis mine).

'Medical strategies to prevent end-stage organ failure

The prevention or delay of end-stage organ failure must be accomplished to reduce the need for organ transplantation and to achieve national self-sufficiency. This approach is especially relevant to low-income countries, where resources can be better used for other pressing medical needs. Thus, education programmes about organ donation for the public and the media should also address the maintenance of a healthy lifestyle. Early detection and prevention of diseases leading to end stage organ failure, such as diabetes, cardiovascular disease, and kidney disease, is necessary.'

Bibliography

1. Organ Procurement and Transplantation Network

2. Williams, Roger, et al. "Addressing liver disease in the UK: a blueprint for attaining excellence in health care and reducing premature mortality from lifestyle issues of excess consumption of alcohol, obesity, and viral hepatitis." The Lancet 384.9958 (2014): 1953-1997.

3. Williams, Roger, et al. "Implementation of the Lancet Standing Commission on Liver Disease in the UK." The Lancet 386.10008 (2015): 2098-2111. https://www.researchgate.net/pro...

4. Wild, Sarah H., et al. "Type 2 diabetes and risk of hospital admission or death for chronic liver diseases." Journal of hepatology 64.6 (2016): 1358-1364.

5. Williams, Bronwen, Michelle Clayton, and Joanne Bosanquet. "Obesity: a growing threat to liver health." Gastrointestinal Nursing 13.Sup10 (2015): S16-S19.

6. Miller, Melanie. "A proposed solution to the present organ donation crisis based on a hard look at the past." Circulation 75.1 (1987): 20-28. http://circ.ahajournals.org/cont...

7. Truog, Robert D., and Franklin G. Miller. "Changing the conversation about brain death." The American Journal of Bioethics 14.8 (2014): 9-14.

8. Epstein, Miran. "Constructing the Legal Concept of Death: The Counterhegemonic Option." The American Journal of Bioethics 14.8 (2014): 45-47.

9. Scroll, Sanjay Nagral, August 3, 2016. Better buy than die? The unfortunate enduring saga of organ sales in India

10. Epstein, Miran. "The ethics of poverty and the poverty of ethics: the case of Palestinian prisoners in Israel seeking to sell their kidneys in order to feed their children." Journal of medical ethics 33.8 (2007): 473-474. https://www.researchgate.net/pro...

11. Budiani‐Saberi, Debra A., and Francis L. Delmonico. "Organ trafficking and transplant tourism: a commentary on the global realities." American Journal of Transplantation 8.5 (2008): 925-929. https://www.researchgate.net/pro...

12. Danovitch, Gabriel M., et al. "Organ trafficking and transplant tourism: The role of global professional ethical standards—The 2008 Declaration of Istanbul." Transplantation 95.11 (2013): 1306-1312. https://www.researchgate.net/pro...

13. The Economist, Nov 20, 2008. Opting out of opting out

14. Stat, Elie Dolgin, March 18, 2016. Surgeons to test use of infected kidneys for transplants

15. Orandi, Babak J., et al. "Survival benefit with kidney transplants from HLA-incompatible live donors." New England Journal of Medicine 374.10 (2016): 940-950. http://www.nejm.org/doi/pdf/10.1...

16. The Guardian, Amanda Holpuch, May 1, 2016. Drug overdose epidemic has driven increase in organ donors, data shows

17. Tirumalai Kamala's answer to Is xenotransplantation remotely possible?

18. Tirumalai Kamala's answer to What would happen to humans if they were affected by endogenous retroviruses as a result of xenotransplantation?

19. Yang, Luhan, et al. "Genome-wide inactivation of porcine endogenous retroviruses (PERVs)." Science 350.6264 (2015): 1101-1104. http://arep.med.harvard.edu/pdf/...

20. Delmonico, Francis L., et al. "A call for government accountability to achieve national self-sufficiency in organ donation and transplantation." The Lancet 378.9800 (2011): 1414-1418. http://www.who.int/transplantati...

https://www.quora.com/Can-we-genetically-modify-animals-to-procure-organs-for-humans/answer/Tirumalai-Kamala