Should You Experiment on Your Own Health?

Arthur: As a student of epidemics and pandemics in history, every one of them is on a scale. Like we saw with COVID left in its wake terror. If you ask me what's the biggest factor contributing right now to distrust in science, it's COVID and its legacy.

Brent: Welcome to the Life Lab by Death Clock. I'm your host, Brent Franson. The mission of Death Clock is to help 100 million people live ten years longer. Today, we speak with Doctor Arthur Caplan about bioethics and self-experimentation. Doctor Caplan is the founding head of the Division of Medical Ethics at NYU Grossman School of Medicine. He's one of the most prominent and widely cited bioethicists in the country.

Brent: So we start the conversation talking about GLP-1s and experimenting with yourself in off-label use cases—using these drugs in a way that they're not prescribed for—and how he thinks about that. And then we talk about the ethics of medicine. He's been a very vocal proponent of COVID vaccine mandates. He's studied very extensively the ethics of organ donation.

Brent: It's a wide-ranging conversation. He's a wonderful guest. Hope you enjoy.

Brent: Doctor Arthur Caplan, welcome to the show.

Arthur: Hey, thank you so much for having me.

Brent: So you have written a bunch of books. You'll tell us how you summarize it, but on the ethics of organ donation, on how we should think about vaccines and whether or not they're mandatory. You're a bit of a polymath within your field, so I'm excited to jump in.

Brent: I want to talk primarily about the ethics of experimenting on ourselves and how we should think about that in the context of health. But before we do that, can you give us a sense of your bio?

Arthur: So I have been around the field so long that I just retired. I started out doing bioethics—ethics issues concerning medicine—probably in 1975, and have been at a number of schools setting up medical ethics/bioethics programs. By the way, medical ethics is the ethical issues raised by medical care, doctors, nurses, and hospitals. Bioethics is the bigger picture: what do we do about animal research?

Arthur: What about AI? What about synthetic biology where you make viruses, public health questions, that sort of thing. So for anybody wondering what the difference is, that's the difference. And as I said, I've been at Columbia, Pittsburgh, Minnesota, Penn, and finished up with a pretty long run of 13 years at NYU Grossman Medical School in New York City running programs in all these places.

Arthur: We grant master's degrees in bioethics, which didn't exist when I started, but turned out to be fairly popular. We teach a lot of classes for med students, public health students, and nurses, and we do a lot of research, so we study different issues. Social scientists will work with us; we'll survey people about attitudes, take a look at how doctors make decisions, what data they pay attention to, what they don't, and what patients listen to in informed consent.

Arthur: And I'll sum it up by saying I'm not disappearing even though I retired. I'm doing fewer budgets and more of what I want. That's a nice angle of retirement, but this is really interesting. It's part of almost the culture now—we hear from ethicists about this, that, and the other thing. But when I started, there was nothing.

Arthur: And it's been amazing to watch the field of ethics within the life sciences and healthcare grow.

Brent: Yeah, wonderful. We've been talking a lot, and I'd be curious for your perspective on this. I've been trying to get a sense of, in a world where everybody has to do their own research and we can't trust anybody—I say that with air quotes because I don't think that's entirely true—

Brent: how do we separate signal from noise? I think one of the things we might look at in the context of a researcher or research is something like an index. So you've published 700 or 750 papers. The h-index would be: how many of those papers have been published?

Brent: A minimum of x times. I think in your case it's an h-index of 79, meaning 79 of them have been cited externally at least 79 times. You've got tens of thousands of citations—I think at least 20,000. That can be a really good way of separating signal from noise. In fact, that's how search engines work.

Brent: Google's big breakthrough was when they were PhD students and asked, "How is the value of our work going to be determined?" It's going to be determined by how many citations there are. In the case of the internet, that's incoming links. How many third parties are linking to a particular piece of content will determine its authority.

Brent: So you've got a very high h-index. I'm sure you don't run around talking about your h-index; you're more modest than that. But do you think that's a good way to separate signal from noise if I'm reading something online from somebody—to say, "What is this person's h-index?"

Arthur: It certainly is an important dimension. If I'm reading a claim anywhere, looking at it not so much from ethics but from the philosophy of science, you want to know: what is the warrant? What is the justification for believing something that somebody says—whether they're on social media making a claim, or RFK Jr. talking about autism and vaccines, or Art Caplan saying that vaccines ought to be mandatory? I don't start with the h-index.

Arthur: The first thing I start with is: where is this being presented? Where is the claim being made? We have peer-reviewed journals. People have to follow certain formats to get into them, meaning they have to have a hypothesis, methods, evidence, and show statistical significance.

Arthur: Does that mean everything that's in the journal is true? No, but it does mean peer-reviewed journals are plausible. So where it appears is the first question I would ask. What's the outlet? What shows up on Joe Rogan's show? I don't know about that outlet. It's a free zone of opinion—nobody's checked or challenged it. Second, who's the author? That's where you get to the h-index.

Arthur: Who says this, and how much experience and background are they bringing to the subject? RFK Jr., for example, recently got into it with Dana Bash on CNN. They were arguing about Tony Fauci, and he said, "Well, you can't understand what I'm saying because you're not a scientist." Her retort was, "Well, you're not either," which is true.

Arthur: He's a lawyer, so you're a little less likely to buy into claims about science from lawyers. Not that they're wrong or couldn't learn it, but they don't have immediate credibility. The other thing that is important, in addition to that, is how often the author or article is cited. The h-index reflects the impact of what they say.

Arthur: Why do I think mandates are important? Because when you take them away, smallpox comes back. Why do I think mandates are important? Because when you don't have them in place, flu goes nuts. So it's partly pragmatic: you make a claim, then back it up with evidence from the real world.

Brent: I want to come to vaccines and the ethics of organ donation, but I want to start with the self-experimentation trend that we're seeing. I was talking to a family member at a family reunion earlier in the week, and somebody was asking me about low-dosing GLP-1s to lose 15 pounds.

Brent: That's an off-label usage for someone who is not obese. On-label usage is for obesity—those have been studied through randomized controlled trials and approved by the FDA. But they're increasingly being used off-label to lose a few pounds, reduce inflammation, or improve heart health, because there seem to be several different benefits.

Brent: So how would you respond to that family member?

Arthur: Well, let's take that case, and then we can talk a little more about do-it-yourself or self-experimentation, which I've been tracking for a long time. In that case, many drugs—people aren't aware of this—only work at a threshold. You have to take a minimum amount to get any effect; otherwise, you're just paying for expensive urine.

Arthur: You take them in, you pee them out, and they don't do anything. Would low doses have small impacts that help you lose weight? Believe it or not, I don't think so. I think we've studied that drug enough to know it's a threshold-type thing. Also, the impact is related to your initial size, your metabolism, and different doses prescribed by doctors.

Arthur: You can get 7.5 mg, 12.5 mg, or 15 mg. The company knows that to get certain results, whether for diabetes control or weight loss, you probably have to be above 7.5 mg a week for any of these things. Once you drop below that, you don't see it. I was the ethics advisor—this was a fun job—on Viagra years ago.

Arthur: Many years ago, when Pfizer first came to market, they asked me to help them think about the ethical issues of Viagra. One thing we found out quickly was that dose mattered in two ways. If you didn't get up to a threshold dose, whatever the minimum pill size was going to be, you didn't get an observable result in terms of erections. But going above the effective dose didn't have additional benefits.

Arthur: If you swallowed the bottle, you weren't going to do any better than if you took the recommended dose. That was known, and the packaging for that pill—still somewhat true today—tries to put it in plastic wrap so you have to take one pill at a time and go through the aggravation to take more.

Arthur: So I'd advise that person to be careful. I'm not saying you can't try it or that it's not your risk to take, but you have to understand that in drug pharmacology, dosing is specific to the person.

Arthur: It depends on what else you're eating. If you're drinking sugary beverages all day and take a tiny dose, it isn't going to make you lose weight. Taking tiny doses to the extreme is what homeopathy is—the movement claiming tiny doses of things help, but there's no evidence that's true.

Arthur: Remember the threshold. Maybe try it, but if I didn't see changes within a month, I'd say I need to get a prescription.

Brent: I wonder what you think of the more pernicious downside cases, because what you're illustrating there is that you might be wasting money and buying expensive urine. A lot of people might respond, "If there's some chance it's really helpful—I heard about it on a podcast or TikTok video—"

Brent: and the worst-case scenario is wasting a little bit of money, that's fine." But my mind goes to Fen-Phen and other terrible examples of off-label usage gone wrong. In the case of thalidomide, which was a sedative, people noticed it helped with nausea, and some doctors started prescribing it off-label in the first trimester.

Brent: And then you have these horrible outcomes.

Arthur: In fact, if you're pregnant, don't experiment with anything. That process is so sensitive that taking any do-it-yourself medicine, nutritional supplement, or off-label treatment—even for migraine control—is unsafe during pregnancy because we know fetal development is extremely vulnerable.

Arthur: That's why they tell you that you can't drink alcohol at all. Even two glasses of wine in early pregnancy raises the birth defect rate significantly. So, my advice: if you're pregnant, don't try anything. If you have an underlying autoimmune disease, be really careful about that.

Arthur: If you're healthy, peptides are still recommended online these days. Even RFK Jr. and his committee said to try them, which I think is nuts. We don't even fully understand how peptides work. What's the biochemical pathway supposed to get you from a peptide to more muscle? Whatever the intervention—St. John's wort or anything else—if I don't see a clear biochemical pathway or explanation, I'm skeptical.

Arthur: I'm nervous about unknown side effects for a small gain that you could replicate by going to the gym. For example, people took growth hormone in professional sports because it builds muscle, but it also causes brain tumors at five times the rate. Lyle Alzado, who played for Oakland in the NFL, was a famous case.

Arthur: He went on growth hormone, which made him violent, aggressive, and bigger, but he died from an incurable brain tumor two years after he started. He said it was the biggest mistake he ever made. There are high stakes when you try things with unknown pathways just because someone at the gym said a steroid would make you stronger.

Arthur: You have to realize that when you take hormones—even Pete Hegseth wanting to put the army on testosterone—it's dangerous. Hormone changes affect all the organs of the body. Now, if you want to take a food supplement whose digestion we understand,

Arthur: and it helps with regular bowel movements or makes you feel fuller, fine. But there's high danger in do-it-yourself experimentation. We see it more in younger people looking for enhancement—they're not just trying to achieve health; they're trying to be better.

Brent: We should exercise the highest level of caution if pregnant—no experimenting whatsoever on such a sensitive process. We'd also advise caution using anything off-label where short- and long-term consequences haven't been studied across a broad population. This brings up Bryan Johnson as an interesting example.

Brent: My opinion on Bryan Johnson, who is experimenting on himself and spending millions of dollars a year doing it, is that he's trying to push longevity science forward. I respect that he's using his own money and sharing his results.

Brent: A fundamental concern I have is that the average person doesn't understand why we study things across whole populations. Just because an approach works for Bryan Johnson and doesn't harm him doesn't mean it will work for you or be safe for you.

Arthur: By the way, did I see that Bryan Johnson just announced he had a pretty bad underlying disease?

Brent: Yeah, he has a chronic digestive issue. I don't know the specifics, but he did announce that.

Arthur: I'm not sure if that's due to anything he was doing or taking; it could be inherited. But it's a reminder that even though many of us think we can extend our lives, plenty of marathon runners drop dead at 40, and plenty of longevity proponents

Arthur: look like they're aging quickly. I'm not sure everything they do works. I'm not saying a great diet, exercise, and habits like Johnson's aren't good, but let me give another warning about longevity claims.

Arthur: Years ago, a lifestyle regimen was put forward for managing type 2 diabetes. It required such extreme lifestyle changes and dietary restrictions that, even with supporting evidence, nobody would stick to it. You needed to be Bryan Johnson to maintain it, so it was forgotten because it was impractical.

Arthur: In the longevity sphere, some people say you add a minute to your life for every minute spent running on a treadmill. My attitude is: you better enjoy being on the treadmill, because adding a minute by exercising means spending that minute running.

Arthur: If you don't like running, you might have a shorter life, but you won't gain truly free time if you spend it doing something you dislike. Will I eat meat or have a sundae once in a while? Yeah. Is eating a tub of ice cream good for you?

Arthur: No. Coffee has been shown to have health benefits, but I like sugar and cream in mine, which negates some benefits. Well, I like it with sugar and cream, so I'm not giving that up. I'm fine giving up butter or certain cooking oils,

Arthur: but I like my coffee, so you have to make those trade-offs in pursuit of longevity and slowing down aging.

Brent: Do you think there's a lack of understanding around how we differ as a population? The origin of so much self-experimentation seems to be anecdotal witnessing of someone else getting a benefit. I saw someone who said they did well on the carnivore diet, or someone who took GLP-1s and saw their inflammation or LDL drop.

Brent: Much of it seems to stem from a lack of understanding that while an outcome was true for that individual, studying 10 or 100 million people on the carnivore diet would show that only a certain percentage benefited.

Brent: The question is: does the average person benefit, and what is the risk-reward trade-off? What is your sense of how pernicious anecdotal accounts are?

Arthur: They're pernicious in a couple of ways. First, the online database skews young and male. What benefits a 29-year-old male trying to enhance performance online may not work for a 55-year-old female, a Bangladeshi man, or a Japanese retiree.

Brent: When you say "that database," you mean the people discussing it online tend to be young males. If you don't fit that profile, your unique biology may respond differently.

Arthur: Correct. We're learning more about unique biological makeup every week. It's driving precision medicine—matching treatments for cancer to the exact tumor type you have. We used to treat stomach cancer or breast cancer with a single broad approach.

Arthur: We used to poison cells broadly. Now, we have genetic interventions to trigger your immune system to target specific cancer cell types based on your immune system, so it doesn't work identically for everyone. You have to know the specific cancer cell type

Arthur: and your immune antibody profile. That's where gene therapy or CAR-T cell interventions come in. Instead of one-size-fits-all, biology shows distinct subgroups, and you can't generalize from one to the next. Some things do generalize: aerobic exercise benefits almost everyone.

Arthur: Wearing a helmet on a bike or motorcycle protects anyone. But for other treatments, it's not clear that results are generalizable, even if an individual testimonial claims success.

Brent: There seems to be a spectrum. On one end, someone completely does their own research and ignores authority; on the other end, someone defers entirely, treating the doctor as a dictator without questioning them.

Brent: The average primary care relationship lies in the middle: the doctor is an authority, but patients choose whether to take medication, seek second opinions, or offer input.

Brent: You refer to extreme doctor authority as paternalism. It feels like society has moved further toward doing its own research, with more skepticism of authority, more time spent self-educating, and weighing personal conclusions over educated experts.

Brent: How do you think about autonomy versus appeal to authority?

Arthur: First, it's an important distinction because it's about ethics, not just science. We've seen three ethical shifts leading to more self-experimentation. First, the history of research had major abuses: people were lied to, killed, underwent surgery without anesthesia, or were abused in orphanages, reservations, or institutions.

Arthur: That created extreme caution about research protocols in the 1950s and 60s. Now, we have greater trust that severe abuses won't happen because research ethics protections are stronger.

Arthur: So people are more willing to try stuff and sign up than they once were. That's a major research ethics shift. The culture has definitely shifted toward a MAGA outlook, which is very individualistic and very autonomy-driven. I don't worry so much about the community, not so worried about my neighbor. I'm worried about me. You can see it in the rich people building their bunkers and rooms to run away to when society falls apart.

Arthur: People are more willing to try treatments and sign up for trials. Beyond research ethics, culture has shifted toward an individualistic, autonomy-driven outlook focused on the self rather than community obligations. You see it in wealthy individuals building bunkers to run away to if society collapses.

Arthur: Even in everyday life, people say, "I don't care about experts; I'm going to decide for myself and be the king of my own body." That's an autonomy-driven ethic rather than deference to authority. The third shift is that scientific understanding is better. In 1950, wellness knowledge was minimal—doctors even smoked cigarettes.

Arthur: In 75 years, we've learned a lot, and there are better ideas floating around. People don't want to wait five years for proof; they want to try things now, trusting scientific capacity. These shifts make people more willing to take risks and demand the opportunity to try treatments.

Arthur: This carries higher risk because protocols bypass older protective frameworks—a mouse study shows a response, and someone tries it immediately. That shift carries personal responsibility to truly understand what you're doing

Arthur: rather than relying on supplement sellers profiting from claims. The US wellness industry hit over $1 trillion last year. There's Big Pharma, but there's also Big Wellness. If you're taking personal authority,

Arthur: you need to be genuinely informed rather than just relying on celebrity endorsements.

Brent: There's an Elon Musk quote: "The most ironic outcome is the most likely outcome." The irony in the Big Wellness versus Big Pharma debate is that you're often much better off trusting regulated medications than supplements.

Brent: Public perception is often flipped. In places like Boulder, San Francisco, or Oregon, average people might trust supplements completely while remaining skeptical of prescription medications. Yet medications undergo strict regulatory testing to demonstrate efficacy, while supplements do not.

Brent: You seem to share that skepticism based on your tone.

Arthur: I absolutely share that skepticism. Running treatments through regulatory processes gives strong reason to trust their efficacy, even if they aren't 100% effective. Even top vaccines aren't 100% effective—if one reaches 90%, people celebrate.

Arthur: Not all biology responds identically to a pill, vaccine, or device. Still, our regulatory framework has delivered safe and effective drugs for decades. The Big Wellness supplement industry hasn't delivered comparable evidence of enhancement.

Arthur: Gains often rely on common-sense health habits: don't drink to excess, get sleep, exercise, eat well, wear a helmet. Basic health principles haven't changed since Aristotle or Benjamin Franklin.

Arthur: Big Wellness sells products on the margins. Following basic health habits offers far greater benefits than relying on commercial wellness products alone.

Arthur: What do you gain beyond the core healthy habits? Maybe six or nine extra months? It's not giving you 30 extra years.

Brent: Shifting to public health policy, you argued vociferously for COVID vaccine mandates. Can you give the short version of that argument from a bioethics perspective?

Arthur: The argument was strong when the initial wave of COVID was lethal. COVID later mutated to become less virulent, and vaccination rates increased. In 2019–2020, my wife ran the VA hospital in the Bronx, and she had to rent freezer trucks for deceased patients.

Arthur: Morgues were overwhelmed by the death toll. During a deadly outbreak, you must take steps to control spread. When a vaccine is available, maximizing vaccination protects both individuals and the broader community.

Arthur: That prevents a deadly virus from spreading unchecked. We had a tested vaccine that worked. During that initial crisis, healthcare workers lacked protective gear, people were dying in high numbers, and nursing homes were overwhelmed—my own mother died in a nursing home from COVID in 2019.

Arthur: It was horrible. In a crisis, mandates protect everyone, especially vulnerable populations like newborns and the elderly with limited immune function.

Arthur: The primary protection for vulnerable people is for others to be vaccinated so they don't transmit the virus. Mandates also protect essential workers like police, doctors, and nurses so health systems remain functional.

Arthur: To protect hospital environments, vaccination was critical. At the peak of the pandemic, I argued that transplant candidates should be required to get a COVID vaccine before elective surgery, which drew criticism.

Arthur: People asked, "Are you denying care over vaccination?" It was about protecting transplant teams working without adequate PPE in high-risk environments.

Arthur: Then effective vaccines were developed rapidly under Operation Warp Speed. I would support mandates during severe outbreaks of diseases like bubonic plague or Ebola.

Arthur: Some politicians reject mandates on principle, but public health measures like quarantines and isolation have existed since the 1800s.

Arthur: George Washington mandated smallpox inoculations for troops at Valley Forge during an outbreak. Mandates are a established tool in public health emergencies.

Brent: There's another side to consider regarding public trust. Communication around COVID, natural immunity, side effects, and origins created skepticism. Public health messaging lost trust during the process.

Brent: Respected scientists like Jay Bhattacharya at Stanford faced suppression of their dissenting views online.

Brent: If a authority mandates a medical intervention, public communication and earning trust are critical. COVID highlighted lessons in public health communication mistakes.

Brent: Would you evaluate that period more charitably?

Arthur: I agree that COVID response demonstrated poor public health communication. Anthony Fauci and other officials relied on top-down directives—masking, isolation, school closures, or cleaning packages—without adjusting explanations effectively as evidence evolved.

Arthur: They relied on traditional public health authority rather than transparent engagement. My support for mandates applied specifically to severe, deadly outbreaks, not minor illnesses.

Arthur: For example, I wouldn't mandate a shingles vaccine. Shingles is painful, but it isn't a deadly pandemic threat to the public.

Arthur: Public health communication failed by failing to cultivate clear communicators and by attempting to suppress dissent rather than engaging criticisms directly.

Arthur: You shouldn't censor critics; you engage them. Natural immunity strategies were tried in Sweden, leading to higher mortality without lockdowns. While I disagree with those policies, open discussion is better than censorship.

Arthur: But I'm not saying never censor. If it's crazy stuff like saying the vaccine was designed to protect Jews and Chinese people and didn't work on anybody else—that was floating around at one point—that's too crazy to be promulgated. I'll make a couple of other points about communication: you need to have people understand that the virus changed.

Arthur: Public messaging failed to adapt as the virus mutated and population immunity changed. Schools should have reopened sooner once risk profiles shifted. Failing to update messaging caused a loss of public trust.

Arthur: People asked why vaccinated individuals could still catch new variants. Public health messaging should have explained that vaccines reduced disease severity even if transmission wasn't completely blocked. Science adapts to new data, and messaging must reflect that.

Arthur: Historically, major pandemics leave distrust and social disruption in their wake. After the Black Death in the Middle Ages, recovery of public trust in medicine and institutions took decades.

Arthur: The biggest driver of current distrust in scientific authority is COVID and its public health legacy.

Arthur: It's COVID and its legacy.

Brent: Prior to COVID, general trust in doctors and vaccines was routine and rarely debated. Public sentiment shifted noticeably post-COVID.

Brent: Your argument on mandates stems from a consequentialist framework: weighing the overall benefits of population-wide vaccination against potential risks.

Brent: Mandates carry social costs and rare side-effects across 350 million people, but you weigh those against preventable deaths from widespread disease transmission.

Brent: And then on the other side of the ledger, I have all of the deaths if we don't do this, so the benefit outweighs the cost. So, it's clear. Let's do it.

Arthur: That's how I evaluate it. It raises the moral question: do individuals have obligations to protect family, neighbors, and community by accepting minor personal risks?

Brent: That framing is delicate because social pressure can be used to compel actions that aren't in an individual's best interest.

Arthur: In a consequentialist framework, the benefit outweighs the harm: low personal risk, significant personal and community protection. Protecting newborn grandchildren, elderly relatives, or immunocompromised neighbors reflects basic community responsibility.

Arthur: Don't visit them in the hospital unvaccinated. I think you should protect your grandma in the nursing home. If you have any sense of community, why don't you protect the guy down the street who has an immune disease? In what sense would you even have a community if you didn't do basic things like try to save their lives?

Arthur: Society accepts many restrictions on personal liberty to prevent harm to others, such as speed limits and drunk driving laws.

Brent: Mandating medical interventions remains complex, particularly in a culture prioritizing individual liberty.

Brent: Protecting vulnerable groups like newborns or nursing home residents is a clear goal, but people remain cautious about authority figures claiming definitive outcomes that may turn out to be inaccurate.

Brent: We're constantly exposed to persuasive claims, which makes top-down mandates controversial.

Arthur: Some argue that school shootings are an inevitable trade-off for second amendment rights, a view I reject. Protecting children takes priority over absolute gun rights.

Arthur: Conversely, I oppose book bans in libraries. Free expression and open access to information should be protected against censorship mandates.

Arthur: When dealing with contagious biological threats like viruses and bacteria, public health mandates are ethically justified.

Brent: Fair enough. What is your view on the ethics of organ donation? Financial compensation for organs is currently prohibited to prevent exploitation where wealthy individuals purchase organs from low-income donors.

Brent: Some argue that allowing compensated organ donation could reduce organ shortages, while black markets create dangerous conditions. How do you view organ donation ethics?

Brent: What's your view on the ethics of organ donation?

Arthur: When transplantation began, ethicists debated market models versus presumed consent models. Under a routine recovery model, organs from deceased individuals are retrieved for transplantation automatically unless an objection was recorded.

Arthur: That system yields significantly more organs than commercial markets. If the goal is addressing organ shortages, routine deceased donation is far more effective than paying living donors.

Arthur: US policy prioritizes bodily autonomy, religious objections, and voluntary opt-in donation systems over mandatory retrieval policies.

Arthur: Presumed consent systems with opt-out provisions increase available organs efficiently while respecting explicit objections.

Arthur: Debates in the US often default to market-based solutions, but public service obligations—like military conscription during wartime—demonstrate that society sometimes prioritizes collective needs over absolute individual choice.

Arthur: That's what the draft used to be for armed service. You're going to die in World War II. We know you could die, but we're going to win this war. Thank you, and let us know about your objections from the foxhole. We did it, and I'm sure we'd do it again if we got into a big enough war.

Arthur: Regarding organ markets: I chaired a joint UN/EU committee on organ trafficking. Regulating commercial organ markets effectively is extremely difficult, and unregulated markets lead to severe exploitation and human trafficking.

Arthur: Brokers exploit vulnerable individuals, fail to provide follow-up medical care, and abandon donors post-surgery. Oversight costs for commercial organ systems are prohibitively high.

Arthur: Additionally, performing non-therapeutic surgical removal of a healthy organ from a living donor in exchange for money violates core medical ethics principles of non-maleficence.

Arthur: You're not making them healthier. You're just letting them make money.

Brent: And it makes the donor less healthy overall.

Arthur: It harms a healthy donor for financial compensation rather than medical necessity. While doctors earn fees for performing transplants, removing a healthy organ solely for payment creates severe ethical conflicts.

Arthur: If xenotransplantation research—such as modified porcine organ transplantation being developed at NYU—succeeds, living kidney donation will likely be phased out entirely due to donor risks.

Arthur: Really? If I want to help my sister, I'll do it. But I'll live with the fact that my kidney function is down. And if I injure my one kidney, that's going to be bad for me. So those are really why I'm nervous about markets. But I always laugh when someone tells me we've got to have more organs.

Arthur: It's like, okay, draft them.

Brent: Using a public draft model for organs like military conscription is a strong comparison. Thank you for sharing your insights.

Arthur: A system with religious or conscientious opt-outs would still fulfill transplant needs effectively.

Brent: Doctor Arthur Caplan, thank you so much for your time and work. I really enjoyed the conversation.

Arthur: Thank you. It was a great conversation.

Brent: The Life Lab by Death Clock is recorded in Boulder, Colorado, and San Francisco, California. Produced by Patrick Godinho, music by Patrick Lee, and hosted by Brent Franson, founder and CEO of Death Clock.