我的《信報》文章(2022年9月27日A18頁)刊登後的改良加長版
《香港濟貧後初踐扶貧 與 美國有償「捐」血漿》
https://www1.hkej.com/dailynews/article/id/3256831
9月6日，《紐約時報》一篇題為「…賣我的血漿」的文章，描述作者在美國有償捐血漿的親身經歷。並於收取100美元後這樣寫:「人們以血漿獲酬沒有不當…我只認為捐者應該獲付更多(donors should be paid more)」。
[Note 1a]
血漿(blood plasma)是抽血時紅血球、血小板等其他成分，安全地由儀器輸回被抽血者，最後只有血漿留在袋/瓶內;血漿可作輸血、製藥之用。
[Note 2]
此文來得正巧，因為一位謙稱「錢莊小主管」的讀者以電郵賜教。除了對「附到期日貨幣」提贈高見外，還鼓勵我對「貧富懸殊不是大問題…『為富不仁』才是問題的核心」之言(見7月拙文) ，多添闡釋。
[Note 3]
根據「經合組織」(OECD)的2001年歷史研究報告《The World Economy — A Millennial Perspective 》，
公元元年的全球人均國內生產總值大約是 444美元，
到 1870年僅僅增至 867元;
但隨着科技的爆炸性創新發展，在一個世紀後的1998年已急增到 5,709元。
最新的統計是2020年的12,263美元。
故傾向相信貧富差距擴闊的主因是科技進步，而較少人能抓住其衍生的機會積累巨額財富。
[Note 4]
儘管營商者會嘗試淘汰競爭對手，唯早在 1759年，亞當·史密斯於其《道德情操論》內，已強調謀利圖財為富者必須遵守道德原則(包括審慎prudence、行善beneficence) 。
[Note 5]
可惜言者諄諄，聽者藐藐。從昔日的槍砲殖民到今天的金融掠奪，為富不仁的行為隨處可見，給窮人帶來不必要的艱苦。
華夏文化的濟貧傳統在香港從未中斷過，民間有贈醫施藥、派米送毯。政府有
廉租住房(寮屋區連串災害及石硤尾大火後展開)、
免費教育(提高生產力)、
便價醫療、
綜援津貼;
而前兩者既助民眾安居樂業，
亦具備帶動向上流動社會階梯以脫貧的積極副作用。
但禍患總是接二連三。濟貧緩解了日常衣食住行之困，脫貧的機制也如常運作(例見2002年考獲10A成績的「綜援狀元」入讀港大醫學院)，社會卻出現了新一類的跨代貧窮現象。
[Note 6]
主事官員及一些前線社工已察覺其本質有别於往昔。2012年成立扶貧委員會，推出「師友計劃」，旨在幫助學員啟發「正面思維」; 再於今年試行「共創明『Teen』計劃」，以「積極正向的態度」定下個人目標，培養「正確理財觀念」」，建立「正向人生觀」，力爭上游。
[Note 7]
扶貧有至少兩個特點。
一是提高心理質素，而非提供金錢、物資。目前，貧窮青少年缺乏的不是可支配的錢，而是鬥志、恆心、毅力。缺乏意志的成因錯綜複雜，身邊有太多的誘惑是關鍵之一，而最破壞人格的誘惑是「比倣」(emulate)。
[Note 8]
能夠像其他(同齡)人一樣，迅即享受吃喝玩樂的五官滿足，是一種難以抗拒的吸引力。大量商人更提倡即時滿足慾望的消費價值觀:
以往重視「天長地久」的珍惜，
現在吹捧「只在乎曾經擁有」的刺激;
以往表揚「小富由儉」的克己，
現在要「擁抱當下」、「零等待」。
理財觀念也有顯著變化:
以往「落街冇錢買麵包，借錢又怕老婆鬧」，
現在容易借錢的宣傳排山倒海;
以往期望「出咗半斤力，想話攞番足八兩」，
現在只求賺快錢買「心頭好」，無視工資低於付出的辛勤、承擔的風險。
另一項扶貧特點是服務對象有選擇性。因傷病、劣習(如黃賭毒) 導致的貧困，已有其他方式給予救「濟」。故此被扶貧的人以「幼有所長」為優先。
對於須同時照顧孩子的低薪工人，除了予以指導以保持身心健康，還要提供協助，達到家庭和睦萬事興。
而對於正在成長的貧困少年、兒童，學習「積極正向的態度」及修養「正向人生觀」，當然必不可少。一旦少年時染上快花錢成習慣，畢業後就業，很容易會失自控地犧牲身心健康去賺快錢、借快錢。
無處不在的為富不仁者，會利用這類窮人的賺快錢心理圖利，導致他們陷入自貧的惡性循環，播下跨代貧困的種子。
為富不仁的普遍程度既廣且深，號稱救病扶傷的醫藥業經營商也難免。
2021年，血漿產品市場規模約為240億美元，而美國是全球最大的血漿出口國，佔其出口總額多達2.69%;因為縱使抽血過多會損害免疫系統，美國仍然允許一個人每年被抽血多達 104 次，冠絕全球(香港24次、英國26次、德國60次) 。
[Note 9]
血漿中心主要由三家公司經營，一公升血漿總成本約為 150 美元，轉手即以 500美元賣出。
[Note 10]
本文不評論賣血的道德問題，只提出兩點。
一是賣血者的報酬過低(underpaid)。根據上述《紐時》文章，100美元是首次給賣家的賞金，常客(regulars) 每次只能得到40-60美元。血漿可挽救寶貴的生命，但冒着健康風險的賣血者只能得到這麼少的金額;相反，醫療營商者從中獲利頗豐。
[Note 1b]
製藥的利潤固然以萬、億計算，輸血也能帶來豐厚利潤。2011 年發表的一項調查發現，美國213所醫院的輸血
平均成本每單位為210.74±37.9 美元，
平均收費卻高達 343.63±135 美元
(一家香港私營醫院輸血一次收費1,240至2,150港元，視病房等級而定, 香港紅十字會免費提供血液) 。
[Note 11]
香港賺血汗錢的基層工人的報酬也過低。與美國醫療體系相比，最低工資辯論實際上忽略了港府通過醫管局向基層(長工時)勞工提供便價醫療，已對僱主作出補貼。
另一點是美國在自由市場的大旗下，散佈在貧窮社區的「賣血站」對鄰里居民，尤其是孩子們，構成不良心理影響;不僅導致自我形象低落，還會自暴自棄，靠賣血賺快錢來獲得所謂的快樂生活 (2018年，英國《經濟學人》呼籲全球把有償捐血漿合法化)。
[Note 12]
相反，香港官民在心態、價值觀層面合作扶貧，值得高度表揚及積極支持。不管是直接擔任導師，或提醒親友警惕市面流行的諸種劣品缺德消費宣傳、行為，都有助於貧困孩子建立「正向人生觀」，不讓香港像美國般進入「吸血新世紀」。
同時，也感謝你無償捐血。
Notes for reference
[Note 1a]
2022 Sep 9
New York Times
“The Exceptionally American Experience of
Selling My Plasma”, By Vanessa Veselka
https://www.nytimes.com/2022/09/09/opinion/plasma-donation-poverty.html
I was paid $100 for my recent
donation. …
I have no problem with people being
paid for plasma. I just think that companies should take less
of the plasma, and that donors should be paid more.
[Note 1b]
2022 Sep 9
New York Times
“The Exceptionally American Experience of
Selling My Plasma”, By Vanessa Veselka
https://www.nytimes.com/2022/09/09/opinion/plasma-donation-poverty.html
I was paid $100 for my recent
donation. The next donation will pay me $125 plus
$10 more from a coupon I was given, but only if I go back within 45 days. If I
go back later, I lose the new donor benefits and will
make only $40 to $60 like the other regulars.
[Note 2]
2022 Sep 9
New York Times
“The Exceptionally American Experience of
Selling My Plasma”, By Vanessa Veselka
https://www.nytimes.com/2022/09/09/opinion/plasma-donation-poverty.html
The phlebotomist punctured a vein in my arm with a 17-gauge needle and
had me pump my fist until the blood started to flow up the line and into the
machine where it would be separated into red and white
blood cells, platelets and plasma. The plasma would go into the bottle, and the
rest, along with complimentary saline solution, would flow back into me.
Hong Kong Red
Cross Blood Transfusion Service
https://www5.ha.org.hk/rcbts/donation-apheresis?lang=tc
血液是由紅血球(紅細胞)、白血球 (白細胞)、血小板和血漿組成的。
…當您曾重覆捐血後而沒有任何不適便可考慮捐贈成分血，中心利用先進儀器於捐血時選擇捐出血漿、血小板或兩者一起捐贈，其他血液成分如紅血球等則安全地由儀器輸回到捐贈者。
https://www.blood.co.uk/why-give-blood/how-blood-is-used/blood-components/plasma/
What
is plasma used for?
Plasma
can be given as a transfusion or made into medicines
[Note 3]
2022
July8/F (《信報》 2022年7月8日A19頁)
《勸戒厚酬銀行家 與 翻譯《論語》的詩人龐德》
https://www1.hkej.com/dailynews/article/id/3183305
2022
Aug2/T (《信報》
2022年8月2日A18頁)
《美元武器化 與「附到期日」貨幣》
https://www1.hkej.com/dailynews/article/id/3204277
[Note 4]
OECD 2001
The World Economy — A
Millennial Perspective, by Angus Maddison
Table B-21 World GDP per capita 0-1998
A.D.
https://read.oecd-ilibrary.org/economics/the-world-economy_9789264189980-en
p.265/385
[Note 5]
Adam Smith Institute
“The Theory of Moral Sentiments”
https://www.adamsmith.org/the-theory-of-moral-sentiments
…Virtues. Smith ends The Theory Of Moral
Sentiments by defining the character of a truly virtuous person. Such a person,
he suggests, would embody the qualities of prudence, justice, beneficence and
self-command…
Wiki, The Theory of Moral Sentiments 1759
https://en.wikipedia.org/wiki/The_Theory_of_Moral_Sentiments
The Theory of Moral Sentiments is a 1759
book by Adam Smith.[1][2][3] It provided the ethical, philosophical, economic,
and methodological underpinnings to Smith's later works, including The Wealth
of Nations (1776), Essays on Philosophical Subjects (1795), and Lectures on
Justice, Police, Revenue, and Arms (1763) (first published in 1896).
[Note 6]
baike.baidu.com/item/李奇光/15617042
李奇光，男，漢族，2002年以10A成績成為會考狀元的李奇光，是觀塘瑪利諾書院有史以來首位十優生，幼年喪父，一家三口領取綜援過活，因而被稱為“綜援狀元”。
[Note 7]
扶貧委員會 「師友計劃」
https://www.povertyrelief.gov.hk/chi/future_starplan.html
https://www.povertyrelief.gov.hk/chi/pdf/2021_FSMP_Programme_Brief_c.pdf
希望透過個人友師分享他們的生命故事，啟發得獎學生的正面思維，擴闊他們的生活視野，陪伴學生探索生涯規劃，提升他們對自己未來的希望感，從而促進他們向上流動的能力。
共創明『Teen』計劃
https://www.swd.gov.hk/tc/index/site_pubsvc/page_young/sub_strive_and_rise/
師友配對：
為每名學員配對一名義務友師，與學員分享人生經驗，幫助學員加強自信，以積極正向的態度定下個人目標；以及幫助學員培養正確理財觀念，有效使用計劃提供的財政支援
目的：
推動學員開闊眼界，加強自信，建立正向人生觀，為自己未來定下目標，力爭上游
[Note 8]
詳見拙文
2022
Apr 6/W (《信報》
2022年4月6日A12頁)
《低酬誘少年運毒 與〈有閒階級論〉》
https://www1.hkej.com/dailynews/article/id/3094745
[Note 9]
2021 March 11
Business Insider
“Business is booming for the $24 billion
plasma industry — but it may be putting vulnerable donors at risk”
https://www.businessinsider.com/plasma-donating-industry-vulnerable-health-2021-3
The US supplies two-thirds of the world's
plasma, and it's one of the few countries where donors get paid.
In fact, thousands of Americans rely on
plasma donation as a main source of income.
For thousands of Americans, donating
plasma is a lifeline. In the 90 minutes it takes to donate, they make five
times the federal minimum wage.
Americans supply two-thirds of
the world's blood plasma. The industry is worth over $24 billion today, according to the Marketing Research Bureau, and that number
could nearly double by 2027, as global demand for plasma-derived medicine rises
by 6% to 8% each year.
2022 June 30
CNBC
“Why blood makes up over 2.5% of all U.S.
exports
https://www.cnbc.com/2022/06/30/why-blood-makes-up-over-2point5percent-of-all-us-exports.html
Blood makes up 2.69% of U.S.
exports, according to the Census Bureau.
2018 March 15
The Atlantic
“How Blood-Plasma Companies target the
poorest Americans”
https://www.theatlantic.com/business/archive/2018/03/plasma-donations/555599/
This all has been a boon for the industry.
Over a decade, the number of donations—really, “sales” is a more accurate
noun—in America tripled, from 12 million per year in 2006 to 38 million per
year in 2016, according to the Plasma Protein Therapeutics Association, a trade
group. The number of donation centers in the U.S. has
more than doubled to meet demand, from fewer than 300 sites in 2005 to over 600
today. Global sales jumped from $5 billion in 2000 to $20 billion in
2015, and are expected to keep growing at a rapid clip well into the next
decade.
2022 Sep 9
New York Times
“The Exceptionally American Experience of
Selling My Plasma”, By Vanessa Veselka
https://www.nytimes.com/2022/09/09/opinion/plasma-donation-poverty.html
The problem is that while plasma does many wonders for those who receive treatments derived from it, its removal threatens the health of the people who sell it. Repeated plasma donations can weaken a donor’s immune system and lead to other negative side effects. Very few countries allow payment for plasma, in part out of concern that financially vulnerable people would risk their health for money.
Other developed nations place stricter limits
the number of times one can donate. In Britain, plasma
can be given every two weeks; in Germany, it’s up to 60 times a year. The
United States allows a person to sell plasma 104 times year.
[Note 10]
2021 March 11
Business Insider
“Business is booming for the $24 billion
plasma industry — but it may be putting vulnerable donors at risk”
https://www.businessinsider.com/plasma-donating-industry-vulnerable-health-2021-3
According to analysts at Fortune Business
Insights, two-thirds of these centers are owned by one of three companies: CSL Plasma, Grifols, and BioLife.
2018 March 15
The Atlantic
“How Blood-Plasma Companies target the
poorest Americans”
https://www.theatlantic.com/business/archive/2018/03/plasma-donations/555599/
Because
plasma can be a medical necessity, companies that collect it tend to wield
significant pricing power. These days, a liter of plasma that costs a company
about $150 to collect and process could sell
for in the neighborhood of $500—a
substantial markup in any industry.
[Note 11]
2011
National Library of Medicine
“Costs to hospitals of acquiring and
processing blood in the US: a survey of hospital-based blood banks and
transfusion services”
Richard W Toner 1, Laura Pizzi, Brian
Leas, Samir K Ballas, Alyson Quigley, Neil I Goldfarb
PMID: 21174480 DOI:
10.2165/11530740-000000000-00000
https://pubmed.ncbi.nlm.nih.gov/21174480/
Results: a total
of 213 surveys were completed. The mean (SD) acquisition cost for one unit of
red blood cells purchased from a supplier (n = 204) was $US210.74 ± 37.9 and
the mean charge to the patient (n = 167) was $US343.63 ± 135. There was
significant statistical variation in acquisition cost by US census region (p
< 0.0001) and division (p < 0.0001).
Hong Kong Sanatorium & Hospital
Blood Transfusion Administration Service
Fee
https://www.hksh-hospital.com/en/fees-and-charges/blood-transfusion-administration-service-fee
[Note 12]
2018 May 10
The Economist
“Bans on paying human blood distort a
vital global market”
