Simone woke up to a 5am text thread claiming brain death was invented to harvest organs — and the more she dug, the worse it got. This episode walks through the TJ Hoover case (a man wheeled toward organ recovery who was crying, thrashing, and later survived), the 1968 Harvard “irreversible coma” paper that built the modern framework, the Lazarus sign, the apnea test, paralytics used during recovery, hospital reimbursement incentives, and a New Jersey case where an organ procurement group treated donor registration like a lifetime contract the family had to fight in court.
If you only do one thing after watching: check your license and the actual donor registry. Taking the heart off the card is not always enough. Tell the people who would show up at the hospital. Put a revocation in your advance directive.
Not medical or legal advice. Organ transplants save lives. The question is whether the current definition, incentives, and paperwork are honest enough to trust.
Show Notes
The Case of TJ Hoover
SIMONE’S SOURCE: It’s not real, lots of people survive incurable brain death, most famously and most recently TJ Hoover
According to some reports, A person who has actually met a complete, correctly performed formal determination of brain death/death by neurologic criteria (BD/DNC) does not recover.
By definition, the determination requires permanent loss of function of the brain as a whole, including the brainstem
A later recovery means the person was not, in fact, brain-dead under the applicable standard, or that the diagnosis/process was incomplete or erroneous.
THE PROBLEM IS THAT IT DOESN’T SEEM PEOPLE ARE CORRECTLY DIAGNOSING, because TJ Hoover was one of those people.
Anthony Thomas “TJ” Hoover II was hospitalized in Richmond, Kentucky, in October 2021 after a drug overdose and cardiac arrest, according to reporting based on family and former-organ-procurement-worker accounts. He was severely neurologically impaired and entered an organ-donation pathway. His family says they were told he was brain-dead or dead
The reported sequence is alarming:
While he was being moved toward the operating room, Hoover’s sister said she saw him open his eyes and look around; she was reportedly told this was a reflex.
During a cardiac catheterization intended to evaluate his heart for potential transplantation, former staff members said Hoover woke or thrashed and was then sedated.
When he reached the operating room for planned organ recovery, a preservation worker described him as moving, thrashing, and visibly crying. Two physicians reportedly refused to take part, and the organ-recovery surgery was stopped.
Hoover survived. Reporting describes ongoing impairments in memory, walking, and speech, and says he lives with his sister, who is his legal guardian.
The allegations prompted review by Kentucky authorities and a federal investigation by the Health Resources and Services Administration (HRSA), according to NPR’s 2024 reporting
So what on earth happened???
Did Hoover survive? Yes
Did family members understand that he was “brain-dead” or “dead”? Yes.
Was there a completed, valid, documented formal BD/DNC declaration?: Disputed
There are also cases of people recovering from formal brain-death declarations
The strongest published case that can plausibly be described as survival after a formal brain-death declaration involves a baby girl:
A female infant born at 35 weeks’ gestation suffered a cerebral hemorrhage.
She was declared brain-dead between approximately 40 and 120 hours after birth.
The report stated that apparent confounders were absent.
Instead of deteriorating, she gradually regained neurologic function and was reported healthy at one-year follow-up.
But it’s complicated: Current neurological guidance does not endorse determining brain death in infants born before 37 weeks’ gestation because the neonatal examination and diagnostic evidence have not been sufficiently validated in that population. The 2024 review expressly treats the case as a historical misdiagnosis under standards that should not now be used for that patient.
The 1968 Harvard Paper on Brain Death
SIMONE’S SOURCE:…it is impossible to harvest transplantable organs from an actual dead person
IMPOSSIBLE
Go get the original Harvard 1968 paper on brain death
Their very clear. There will be no public support for killing people for their organs
Therefore, we need a new category of death
To create public support for organ donation
THE PAPER
I looked up this paper, and indeed:
It was pivotal to modern brain-dead standards
It explicitly considered organ transplant implications
It enabled procurement of organs from living people
The Harvard Medical School Ad Hoc Committee’s August 1968 JAMA report, “A Definition of Irreversible Coma,” set out clinical criteria for a patient whose brain function was believed to have irreversibly ceased. Its criteria included:
Complete unresponsiveness
No spontaneous breathing
No spontaneous movement
Absence of reflexes
A flat EEG as confirmatory evidence
Repeat testing after 24 hours, with exclusions for confounders such as hypothermia or sedating drugs
It did not use the contemporary statutory formulation “whole-brain death” in the way later laws did, but it was foundational to the modern brain-death framework. Later U.S. law adopted a formulation under which a person may be declared dead after the irreversible cessation of circulatory/respiratory function or all functions of the entire brain, including the brainstem.
The report was allegedly meant to respond to two intertwined problems created by intensive-care technology:
Ventilators could preserve circulation and a heartbeat in patients with catastrophic, irreversible brain injury.
Doctors and families needed a way to determine when continued life support was no longer appropriate—and when death had occurred—even though the heart had not stopped.
HOWEVER, Organ transplantation was also plainly part of the context. The committee stated that “obsolete criteria” for death could create controversy in transplantation, because organs deteriorate rapidly after circulation stops. Declaring death based on irreversible loss of brain function made it possible to recover organs while oxygenated circulation was still being mechanically maintained
Earlier neurologic descriptions of a state like “brain dead” existed, including the 1959 French description of coma dépassé—a state resembling what would later be called brain death. The 1968 Harvard committee’s distinctive contribution was to move from describing profound, apparently irreversible coma to treating it as a criterion of death in U.S. medical practice and, eventually, law.
The Downstream Consequence of This
Under prevailing U.S. medical and legal standards, a properly determined brain-dead patient is dead—not a living patient—despite a ventilator-maintained heartbeat, warm skin, and circulation. Brain-death determination is treated as a death determination, not a prognosis or a consent to withdraw care.
Biologically, such bodies can retain some integrated functions with intensive support: circulation, gas exchange via ventilation, wound healing, hormonal activity, and in rare cases gestation. Those facts are why critics argue that brain death does not always match ordinary intuitions about a dead body.
How “Brain Dead” Patients are Treated Differently if Organ Donors
SIMONE’S SOURCE: Donors are given paralytics
So they don’t move during harvest
They feel everything
Research findings:
Yes, paralytics (aka neuromuscular blocking drug) are used about 90% of the time
Paralytics do NOT provide pain relief or sedation or anesthetization
No, patients are not always medicated for pain, just for organ preservation and to suppress spinal reflexes and stabilize physiology: Per standard procedure, they are not required to prevent conscious suffering because consciousness and pain perception are considered absent.
A review of one center’s cases found that about one-third of brain-dead donors received an opioid, most often fentanyl; about 63% received an inhaled anesthetic such as sevoflurane or isoflurane; and 90% received a neuromuscular blocker.
There are no universally binding national or international intraoperative anesthesia guidelines for brain-dead donor recovery, and protocols vary among hospitals and organ-procurement systems. The review specifically notes limited and conflicting outcome evidence.
The Lazarus Sign
SIMONE’S SOURCE: Oh look up the “Lazarus reflex”
This is when the supposedly dead person tries to fight off the surgeon
The Lazarus sign is a pattern of movement sometimes observed in people declared brain-dead who remain on a ventilator. The person may:
Flex both arms at the elbows.
Raise their arms upward.
Bring the hands toward the neck, chin, chest, or endotracheal tube.
Cross the arms over the chest.
Occasionally lift or arch the upper body.
The standard explanation is that the movement is generated by neural circuits in the spinal cord below the brainstem, without input from the cerebral cortex or brainstem.
There is no sound basis to describe it as a conscious defensive act if the brain-death diagnosis was correctly made.
IF THE DIAGNOSIS WAS CORRECTLY MADE
Because the arms may appear to reach toward the face or tube, people sometimes describe it as “trying to pull out the tube,” “sitting up,” or “fighting the surgeon.” It can be deeply unsettling to see and it deserves a clear explanation before family members witness withdrawal of ventilation or donor surgery.
NOTE: The paper I referenced for some descriptions of this reports on two brain-dead patients who survived for over 100 days after being declared brain dead, who both showed these signs. The paper says organ donation was recommended to both families, but both families refused.
The Apnea Test
SIMONE’S SOURCE: Oh and the apnea test
Where they turn off your ventilator for ten minutes while you’re doped up on paralytics and fentanyl and propofol to “prove” brain death
There is no ethical basis for doing this test because the patient derives no benefit from it and instead can be harmed
In an apnea test, clinicians provide oxygen but suspend mandatory machine breaths long enough for carbon dioxide to rise. They watch continuously for any spontaneous respiratory effort and measure blood gases. If the patient takes even one breath, the test does not support death by neurologic criteria.
Current U.S. guidance specifically requires that sedative effects and pharmacologic paralysis be excluded—not present—before the test can support a brain-death determination
Clinicians are supposed to wait for drugs to wear off before running this test
HOWEVER, we cannot know with certainty that every U.S. hospital—or every clinician in every case—follows the 2023 guidance exactly. The guideline is a national professional standard intended to improve consistency, but it is not itself a real-time enforcement system, and implementation varies by state law, hospital policy, clinician credentialing, and how quickly institutions update older protocols. The guideline’s own authors explicitly acknowledge documented variability in U.S. hospital policies
The Other Activities
SIMONE’S SOURCE: [if] you have agreed to be a donor. They can do all sorts of other sick stuff with you
Transplant a pig kidney and see how long you live
Let residents use you to practice surgery
Checking on this:
Yes, there have been studies in which genetically modified pig kidneys were connected or transplanted into brain-dead research decedents (see: Human Brain-Dead Recipient Model in Solid Organ Xenotransplantation: A Scoping Review of Technical and Ethical Issues)
Yes, trainees may participate under supervision, as with other surgical care
Other things like whole-body donation for anatomy teaching, dissection, etc. and practice surgery should not be presumed permitted; organ donor laws vary from state to state
The Business of Organ Harvesting
SIMONE’S SOURCE: And if you care about health care costs, keep in mind that the main driver of this is the transplants are wildly profitable for hospitals
There is far more money to be made into clearing someone praying dead and harvesting their organs and transplanting them and caring for the transplanties than leaving them in the ICU and giving them time
Findings
To set the scene, broad hospital operating margins are often thin. KFF reported a national average hospital operating margin of 5.2% in 2023, while more recent nonprofit-system reporting found a median 1.5% operating margin in 2024. In that environment, managers care about almost every reimbursable activity—but that does not make every activity a central profit engine.
There is not a single trustworthy national figure for “hospital profit per donor.” Hospital financial statements rarely isolate the donor-hospital margin cleanly, and the accounting differs sharply across hospitals.
HOWEVER: Medicare reported roughly $3.3 billion in claimed organ-acquisition costs in 2016 and reimbursed about $1.6 billion—48%—as its share
And a more recent policy discussion reports that CMS cited 2024 data in which non-renal organ revenue exceeded non-renal acquisition cost by $100 million.
That shows a system-level possibility of over-recovery in a specific reimbursement category
At the very least, it’s clear that a large transplant center with substantial Medicare organ-acquisition activity can receive meaningful reimbursement through its Medicare cost report, and being a high-performing donor hospital can improve the economics of its affiliated transplant programs.
One 2019 conference abstract using fiscal-year 2016 Medicare cost-report data estimated that each organ procured for an OPO or transplant center increased average Medicare organ-acquisition reimbursement by roughly:
$10,918 per kidney
$11,291 per liver
$11,371 per heart
$9,294 per lung
For the sampled transplant programs, the estimated average annual increase in Medicare reimbursement attributable to procurement was approximately:
$456,243 for kidney programs
$593,643 for liver programs
$385,306 for heart programs
$260,504 for lung programs
IMPORTANT: These are reimbursements, not net profits (there are donor-evaluation, OPO, procurement, transport, administrative, and allocation costs).
But a lot of this is likely performed by already-salaried staff, so it’s like getting more billable hours out of them
Getting Off the Organ Donor Registry
SIMONE’S SOURCE: When you do the episode go over how you actually get removed from the registry because it’s not as simple as taking it off your license
There was a recent case of a man in New Jersey who converted to Islam had it removed from his license for religious reasons on the organ procurement organization insisted it was still a lifelong commitment
His family had to go to court
Key findings:
The case reference is a 2026 New Jersey case involving Keith Lott
He had previously registered as a donor through his New Jersey drivers license
Later converted to Islam and did not reselect his donor option when he renewed his license in 2025
while he was on life support, representatives connected to the donation process told them his earlier registration was a “lifetime contract.”
Reporting said Lott’s family ultimately had to seek court intervention in a time-sensitive conflict over donation and burial.
Technically: There is no legal basis in New Jersey law for the claim that a donor designation cannot be revoked during the donor’s lifetime.
Allegedly: NJ Sharing Network reportedly said it accesses Motor Vehicle Commission donor-status information in real time to verify the most current status.
So probably what happened was the organ procurement organization was using outdated records and lying about them
You cannot obtain absolute proof against every database or paperwork error, but you can make your revocation both legally clear and practically difficult to miss.
Make sure your license doesn’t have the designation
Make sure changing the designation = documented (e.g. you print + keep the receipt)
Make sure friends + family know you’re not an organ donor
A strong practical measure is to add a direct statement to your advance directive or health-care power of attorney. For example:
I revoke any prior anatomical gift, organ-donor registration, tissue-donation registration, eye-donation registration, whole-body donation, and authorization for postmortem research or education. I do not authorize the recovery, donation, transplantation, therapy, research, education, training, or other use of my organs, tissues, eyes, or body after death. My health-care agent and family are directed to communicate and enforce these wishes.
Episode Transcript
[00:00:00] Simone Collins: Hello, Malcolm. I’m excited to be speaking with you today because I received a series of texts this morning that sent me down a very dark rabbit hole, and I need to pull you down that hole now. You’re coming with me. So it’s like 5:00 in the morning, okay? And I wake up, and this is what I get. “So you really need to do an episode on how brain death is fake.
Brain death was invented to produce organs for transplantation.” I gotta
[00:00:22] Terrified Man: get out of here. I’m really scared.
[00:00:24] Simone Collins: It’s not real. Lots of people pr- survive incurable brain death, most famously and most recently, TJ Hoover. The Organ Procurement Organization still insists they did nothing wrong in that case, even though the supposedly brain dead man sat in the audience for RFK’s announcement decertifying the OPO.
[00:00:42] Terrified Man: All right, let’s just, let’s calm down. Take a deep breath, okay?
[00:00:45] Simone Collins: Brain death is completely fake and gay, and you should get yourself off the organ donor registry and tell all your friends and family to do the same. Donors are given paralytics so they don’t move during harvest. They feel everything. Come here, come here, come here.
Oh, look up the Lazarus reflex. This is when the supposedly dead person tries to fight off the surgeon. Oh, and the apnea test, where they turn off your ventilator 10 minutes while you’re doped up on paralytics and fentanyl and propofol to prove brain death. There is no ethical basis for doing this test because the patient derives no benefit from it and instead can be harmed.
and if you care about healthcare costs, keep in mind that the main driver of this is transplants are wildly profitable for hospitals.
There’s far more money to be made into declaring someone dead and harvesting their organs and transplanting them and caring for the transplantees than leaving them in the ICU and giving them time.
[00:01:44] Malcolm Collins: So- So- Hold on. Side note before we go further here.
[00:01:46] Simone Collins: Yes. Do
[00:01:47] Malcolm Collins: you remember the fight we had early in our relationship?
Yes. Where you were mad at me because I t- had non-organ donor on my license?
[00:01:53] Simone Collins: Yeah. I was like, “What’s wrong with you? Why are you not an organ donor?” And
[00:01:56] Malcolm Collins: I was like- It’s a selfish thing ... “I’m sorry, I have friends who are doctors, and I know that they will kill people who would otherwise survive
[00:02:02] Simone Collins: for their organs.”
And I didn’t believe you, and I was wrong. I know. I knew this was gonna come up. I
[00:02:08] Malcolm Collins: am ... And now I have organ donor on my license because of you, Simone.
[00:02:12] Simone Collins: Are you serio- oh, are you serious? I thought- We need to get you a new driver’s license. We’re gonna get into this. That’s, that’s at the end, where we’re gonna talk about- This
[00:02:20] Malcolm Collins: is because of you.
You made me get this- ... ‘cause you said I was being unreasonable
[00:02:27] Simone Collins: I didn’t know. I didn’t know because it is ... Right, yeah, she con- she continues, “If you have agreed to be a donor, they can do all sorts of other sick stuff with you.” Oh my God, Malcolm, I’m so sorry. “Transplant a pig kidney and see how you live.
True story. Let residents use you to practice surgery. When you do an episode, go over how you actually get removed from the registry because it’s not as simple as taking it off your license.”
[00:02:51] Terrified Man: It was a nightmare. This was a nightmare. Walked right into a nightmare.
[00:02:54] Simone Collins: There was a recent case of a man in New Jersey who converted to Islam, had it removed from his license for religious reasons on the or- and the organ procurement organization insisted it was still a lifelong commitment.
His family had to go to court. So this is a lot. Okay,
[00:03:12] Malcolm Collins: and I was off the list-
[00:03:14] Simone Collins: And you are off the list ... until you made
[00:03:15] Malcolm Collins: me
[00:03:15] Simone Collins: get
[00:03:15] Malcolm Collins: on the list, Simone.
[00:03:17] Simone Collins: And you are on the list now. You are such a- And we need ... I, Malcolm, I am very sorry. I am very
[00:03:25] Malcolm Collins: sorry. You know what, Simone? See you next Tuesday. Okay? Because this episode’s going live on Tuesday.
[00:03:31] Simone Collins: Oh, God. Okay. Yeah, so anyway, she, she pointed me to this original Harvard 1968 paper on brain death where they’re super clear, she said, “There will be no public support for killing people for their organs, therefore, we need a new category of death to create public support for organ donation.” And that sounds disturbing, but let’s start off with going into the case of T.J.
Hoover because I think that that’s the best place to start. So according to some [00:04:00] reports, a person who’s actually met a complete, correctly performed formal determination of brain death by neurologic criteria does not recover. So the- Oh,
[00:04:10] Malcolm Collins: hold on, hold on. S- s- side note. That is an unhinged series of texts to get early in the morning.
[00:04:15] Simone Collins: I was pretty great. No, she’s
[00:04:17] Malcolm Collins: like the best- That is an unhinged series of- ... in the entire world ... texts to get early in the morning, and I’d be like ... ‘Cause, you know, th- you, you know this person. They’re a fan. W- you talk all the time. Mm. Right. They’re smart. They’re not unhinged. So you come at this and you’re like, “Wait, what?
What? What?”
[00:04:32] Simone Collins: But it’s all ... You don’t understand.
[00:04:34] Malcolm Collins: They’re harvesting people’s organs in the United States? What? And I was like, “Capitalism does have its drawbacks, Simone.”
[00:04:41] Simone Collins: Yeah, I’m, I’m really discovering this. Yeah, look It’s scary. So TJ Hoover, right? So th- h- this is what I’m trying to get at is a big problem with looking into this concept of brain death leading to organ donation, and, like, people incorrectly diagnosing brain death is they’re like, “Well, there’s no such thing as ever coming back from brain death.
You can’t do it. So if anyone comes back from brain death, they were just incorrectly diagnosed.” The problem is if you diagnose someone as brain-dead and they’re on the org- organ registry, they just kill you. So you don’t know if they’re gonna come back from being brain-dead. And, and so that’s kind of disturbing.
So anyway when you try to- Hold on.
[00:05:20] Malcolm Collins: Also, you remember my will around this as well, right?
[00:05:24] Simone Collins: Yes. Yeah.
[00:05:26] Malcolm Collins: Which this team filmed when they were like, “Why does your will say that y- y- that not to take you off at any g- at any cost?” Yeah.
[00:05:32] Simone Collins: Yeah, I’m
[00:05:35] Malcolm Collins: familiar with
[00:05:35] Simone Collins: this. Actually, I guess you do these stories, Simone.
Wait, so what did, what did your friends in the medical profession tell you?
[00:05:38] Malcolm Collins: Oh, it’s, it’s common, even if you know you can probably save somebody, to just l- put them on the organ list. Especially if you’re having to choose between individuals where you’re investing your time. Oh. And you’re like, “Oh, I could work on this person, or I could work on this person, but this person’s on the organ list.
And so it’s not just money from the hospital, but we could save X many additional lives if they die.” So it makes the calculation much easier to decide on this person.
[00:06:05] Simone Collins: Okay, so it’s also, like, a kind of triage issue.
[00:06:08] Malcolm Collins: It’s
[00:06:08] Simone Collins: so
[00:06:08] Malcolm Collins: common there’s a Scrubs episode about it.
[00:06:10] Simone Collins: Oh, God. Well, man, if it’s making it to Scrubs, the f- the friendly non-political-
[00:06:15] Malcolm Collins: Yeah, this has been well known in, like, the industry for a while
[00:06:17] Simone Collins: Oh my...
Okay, great. Well, call me the last person under a rock who did not know this, but here’s what happened to TJ. I
[00:06:24] Malcolm Collins: told you about it.
[00:06:26] Simone Collins: Look- Yeah, I should believe you more. I’m sorry, Malcolm. It’s... What can I say? A waltz, okay?
[00:06:35] Malcolm Collins: A waltz. Exactly. This is a waltz right here. Great.
[00:06:39] Simone Collins: Great, great, great, great.
[00:06:41] Malcolm Collins: All women are like that.
[00:06:44] Simone Collins: Thanks, Malcolm. Anyway, disturbing case of Anthony Thomas, AKA T.J. Hoover II. He was hospitalized in Richmond, Kentucky in October of 2021, so not, like, forever ago, after a drug overdose and cardiac arrest. According, at least, to this report based on family and former organ procurement, procurement worker accounts.
And this is, like, primarily I got this from an NPR piece on it. He was severely neurological impair- neurologically impaired, and he entered an organ donation pathway. So I guess the same, this thing that you’re describing at a hospital happened. Like, oh, drug overdose. This guy’s, like, really, it’s really bad.
Like, shunt him into the organ donation pathway. But then what happened after is pretty alarming. While he was being moved toward the operating room, his sister said she saw him open his eyes and look around, and then she was told by the doctors it was a reflex. And then during cardiac catheterization was, which was supposed to, like, evaluate his heart for potential transplantation, former staff members, note the word former, said that Hoover woke and thrashed, and was then sedated.
So- So
[00:07:57] Malcolm Collins: they fired everyone who saw anything?
[00:07:59] Simone Collins: [00:08:00] I I don’t know exactly how they became former, but I, I think that they quit. Suspicious. But anyway, so they catheterized his heart, and he, it hurt, and he thrashed out, and this is not looking good. And then when he reached the operating room for planned organ recovery, a preservation worker described him as moving, thrashing, and visibly crying.
Two physicians reportedly refused to take part, presumably one of these the former one who had quit, and the organ recovery surgery was stopped. So good on those surgeons for being like, “I can’t do this.” Anyway, Hoover survived and the NPR reporting describes ongoing impairments in memory, and walking, speech, et cetera.
He lives with that same sister who’s now his legal guardian. So he, he’s really- But
[00:08:48] Malcolm Collins: how many times do they not stop? That everyone else in the hospital was just going along with this like they’d seen this happen 100 times before.
[00:08:56] Simone Collins: Yeah, no. We’ll, we’ll actually get into that and why typically it wouldn’t be likely that someone like him would be thrashing on a table even if they weren’t terminal.
[00:09:06] Malcolm Collins: Oh, because they put them under certain sedatives- Mm-hmm ... so you can’t tell, and he was- Oh my God.
[00:09:10] Simone Collins: Yeah. Anyway, Ward did survive. His family members understood, there’s a lot of contention here. There’s an investigation going on, but they say they were told he was either brain-dead or dead. And it’s hard to tell.
Like, it’s disputed as to whether there was a completed, valid, documented, formal brain-dead declaration. And that’s kind of weird, because if there was a formal one that was, like, logged, it would be in their system presumably. So
[00:09:39] Malcolm Collins: why were they taking him to harvest his organs?
[00:09:41] Simone Collins: I don’t know. So that’s-
[00:09:43] Malcolm Collins: Simone, this is so terrifying.
[00:09:46] Simone Collins: Yeah. So uncomfortable. Also, there, there are cases of people recovering from formal brain death declarations. They’re very rare. And- Even the one case that’s really prominent on this front that’s, like, a, a true confirmed recovery, they’re like, “Well, it doesn’t count.” So this, the strongest published case that can plausibly be described as survival after a formal brain death declaration involves a baby girl, and I can only talk about this ‘cause she made it, okay?
But a female infant was born at 35 weeks gestation. And that’s, that’s when Torsten, I think had his C-section. Like, so that’s- Mm-hmm ... that’s premature to the point where, like, at the very least they’d probably need to be in the NICU. And unfortunately, this baby girl suffered a cerebral hemorrhage.
[00:10:32] Malcolm Collins: And then- So the reason why she’s still alive is ‘cause they didn’t need organs of someone that young, it sounds
[00:10:37] Simone Collins: like. Presumably. Well, yes. I mean, I also think, you know, you can’t be living-
[00:10:40] Malcolm Collins: Oh, that’s gruesome.
[00:10:41] Simone Collins: Anyway, she was declared brain-dead between approximately 40 and 120 hours after birth. The report stated that apparent confounders were absent.
And instead of deteriorating, she actually gradually regained neurologic function, and was reported healthy at her year one follow-up. So I’m super, super happy and she’s okay, and this is one baby who’s okay. Mm-hmm. And I’m very happy about that, so this is good. But
[00:11:07] Malcolm Collins: now everyone- You can tell from Simone’s just a little shocked still.
[00:11:10] Simone Collins: I just need, I just need babies to be okay. And the, the guidance around this particular medical case, they’re like, “Well, we, we, we don’t endorse determining brain death in infants born before 37 weeks gestation because the neonatal examination and diagnostic evidence have not been sufficiently validated in that population.”
So they, they’re basically like, “Nah, that was a, that was a misdiagnosis,” ‘cause like, I don’t know. Infants-
[00:11:37] Malcolm Collins: They wouldn’t have had a problem with it had they had taken her organs and sold them for money.
[00:11:41] Simone Collins: I mean, I don’t know. But let’s, let’s get actually to that point of like, so it, it appears to be that in 1968 a bunch of people were like, “Look, there’s this problem, okay?
You can’t really harvest organs from a dead person. You need to harvest them when the person is alive. The problem is people are [00:12:00] not really cool with harvesting organs from living people, so how do we make this work?” And then you have this paper, and this paper, published in 1968 does indeed play a pivotal role in modern brain dead standards.
It explicitly considered organ transplant implications in terms of its like Well, I mean, part of the reason why it’s important to have this designation is organ transplants. And also enable procurement
[00:12:26] Malcolm Collins: of organs from living people So I’m super uncomfortable with, like, everything that’s happening right now.
[00:12:30] Simone Collins: I am too. That’s why, like, this morning I was like, okay. When sh- she was like, ‘You need to do an episode on this, this thing,’ I’m like, ‘Well,
[00:12:40] Malcolm Collins: yes we do.’ Anybody who hears about this needs to talk about this. I want this to go viral in our circles after this. I wanna see Leafly cover this. I wanna see Nucks cover this.
Th- I want this to be very public. I
[00:12:48] Simone Collins: know. All, all the state’s DMV websites are gonna be overwhelmed with everyone being like, “You need to give me a new license now.” Yeah. Because that is, yeah, like the, the number one thing you need to do in case you just don’t have time to listen to this whole episode, is go onto your state’s DMV website and- But
[00:13:05] Malcolm Collins: apparently that doesn’t do enough.
You’ve then gotta contact some other organization?
[00:13:08] Simone Collins: Yeah. It’s a, we’ll, we’ll get into it, but start with the DMV. That like first step, big time ‘cause they’re gonna check your license. Especially when things are happening real fast, if, you know, and your driver’s license is with you, they’re gonna check it, and if they see the wrong thing, they see that heart I don’t wanna know what happens.
Anyway so the Harvard Medical School’s Ad Hoc Committee’s August 1968 JAMA report titled A Definition of Irreversible Cona- Coma, sorry, set out the clinical criteria for a patient whose brain function was believed to have irreversibly ceased, and this criteria includes complete unresponsiveness, no spontaneous breathing, no spontaneous movement, absence of reflexes, a flat EEG as confirmatory evidence, and then there’s supposed to be repeat testing after 24 hours with exclusions for confounders like hypothermia or sedating drugs.
It didn’t actually use the term whole brain death, which later laws did, but it was foundational in creating this framework for brain death. And then later laws in the US in various states adopted formulation under which a person may be declared dead after the irreversible cessation of circulatory and respiratory function for all functions, or all functions in the entire brain, including the brain stem.
And there are, there are different pathways for, like, circulatory and respiratory function cessation and brain deadness. So it’s... But it’s, I think it’s scarier for brain deadness, which is why we’re talking about it. Or I said brain death, sorry. Anyway, the report was allegedly meant to respond to two intertwined problems created by in- intensive care technology, which was getting a lot better in the 1960s.
Like, suddenly ventilators are able to preserve circulation and heartbeats in patients with catastrophic irreversible brain injury. And then they felt that because of this, doctors and families need some way to determine when it would be worth it to continue life support or if it’s better to, like, pull the plug.
And it, you know, I, I understand that. Like, I, I can understand a need for some kind of framework there. It’s just that once you introduce this framework to a system in which hospitals are making a profit, more of a profit from when someone happens to be brain dead, like, you get a problem. Anyway, it’s, the, the issue that is, is that aside from that very logical thing of like, we need to have a talk about this, the organ transplantation issue was prominent and explicit in this report and, and it, it’s not the first thing to discuss.
Jesus Christ. I know. I know. I know. Anyway, the downstream consequences of this meant that under prevailing medical and legal standards in the US, a properly determined brain dead patient is dead. Like, legally they’re dead, despite a ventilator maintained heartbeat, warm skin, and circulation. It’s, it’s treated as death and not a prognosis or a consent to withdraw care.
So it’s, it’s kind of [00:16:00] different from other, other similar, seemingly similar situations. And it’s, Anyway, let’s talk about how brain-dead patients are treated differently if they’re organ donors, ‘cause this is what really, really got me. ‘Cause part of me is like, “Okay, I get it,” right? And, and, and in a lot of cases, people who are
[00:16:19] Malcolm Collins: declared brain-dead- And I, I have to clarify for people.
When she made me put that organ donor thing on my card, she was still a progressive, okay? This was before-
[00:16:25] Simone Collins: Aw, thanks for... Yeah ...
[00:16:27] Malcolm Collins: you converted and woke up to the world is lying to you-
[00:16:31] Simone Collins: This, yeah, guys- ... about more shit than you’re aware
[00:16:33] Malcolm Collins: of ... this was
[00:16:33] Simone Collins: before Simone. It was the before Simone. I feel so bad.
[00:16:37] Malcolm Collins: We just live in a society that lies about everything, and like-
[00:16:40] Simone Collins: Yes
never question ... this was back when I, I don’t know, had more trust in institutions, I guess. Yeah, I,
[00:16:45] Malcolm Collins: Well, that’s a problem. Institutions are pretty evil things.
[00:16:51] Simone Collins: Yeah Yes. I, anyway, ugh right. So if you are declared brain dead, doesn’t matter if they got it right, I guess, you know, like sometimes they get it wrong, as we know from recent cases, but if they declare you brain dead, are you gonna get paralytics?
Yes, you’re going to get paralytics. They’re also referred to as neuromuscular blocking drugs. According to one bit of research I looked at this, everything’s linked in the show notes, about 90% of the time they’re using paralytics. Maybe they didn’t use them with this one guy, you know, who was, is like crying and like f- moving-
[00:17:28] Malcolm Collins: Oh yeah, because they don’t like to deal with that when they’re killing somebody, you know?
[00:17:31] Simone Collins: I, it’s, it’s unpleasant.
[00:17:32] Malcolm Collins: It’s a bummer.
[00:17:34] Simone Collins: So okay, paralytics are used. Are, are patients medicated for pain? No. Are pain meds sometimes used? Yeah. So one review that looked at one center’s cases found that about one third of brain dead donors received an opioid, most often fentanyl, and around 63 received an inhaled anesthetic such as sevoflurane or isoflurane, and about 90% received a neuromuscular blocker.
But is this to medicate for pain, and would, would it actually reduce pain? No. The medication is actually just standard procedure for organ preservation and to suppress spinal reflexes and stabilize physiology. They’re not necessarily enough to prevent pain. And there are no universally binding national or international intraoperative anesthesia guidelines for brain dead donor recovery.
So they’re just gonna use- Well, that’s
[00:18:31] Malcolm Collins: convenient ...
[00:18:32] Simone Collins: whatever they think is appropriate to make, to make the body not move and to keep the organs functioning. But if, I don’t know, if the paralyzed patient is not thrashing and the organs seem okay, they’re probably gonna save on their like pain medication budget.
So I’d not heard about the Lazarus reflex or Lazarus sign. Had you heard of that before?
[00:18:58] Malcolm Collins: I had not, but it sounds like just an excuse for murdering people.
[00:19:01] Simone Collins: I know, it’s like, it’s the, it’s like something, you know, when they, they throw the lobster in the, in the pot of boiling water and they’re like, “Oh, it’s-”
[00:19:10] Malcolm Collins: Just
[00:19:10] Simone Collins: a natural
[00:19:11] Malcolm Collins: reaction that lots of
[00:19:12] Simone Collins: you
[00:19:13] Malcolm Collins: have
[00:19:13] Simone Collins: Yeah.
It’s a, yeah, it’s not, it doesn’t hurt or any- Like, oh my God. Anyway, the Lazarus sign is a pattern of movement sometimes observed in people declared brain dead who remain on a ventilator. This person may flex both arms and elbows, raise their arms upward, bring their hands toward their neck, chin, or chest, or endo- endotracheal take...
Sorry, endotracheal tube. Or they’ll cross their arms over their chest, or occasionally lift or arch their upper body.
[00:19:44] Malcolm Collins: The, one of the really common parts of the Lazarus effect is when they start screaming, “I’m still alive. Please don’t kill me. Please don’t kill me, I have a family.” That’s one of the most common of the symptoms that they have.
[00:19:56] Simone Collins: Ah. Yeah.
[00:19:58] Malcolm Collins: So- It’s a, it’s a [00:20:00] reaction that bodies have when they get scared.
[00:20:02] Simone Collins: Well, yeah. The standard explanation is that the movement is generated by neural circuits in the spinal cord and below the brain stem, without input from the cerebral cortex or brain stem. The, the, there’s no sound basis to describe it as a conscious defensive act if the brain death diagnosis was correctly made.
But that is if the diagnosis was correctly made. And also, like-
[00:20:26] Malcolm Collins: If it’s a real thing other than a diagnosis that they make to get organs
[00:20:31] Simone Collins: And here’s the thing about pain. There doesn’t really seem to be a scientific way to measure pain. Sci- like, doctors don’t have an, a way to know if a patient-
[00:20:41] Malcolm Collins: Yes, there is.
There’s the what, what scale? The scopal scale where they measure pain from, like, insects bites and they... There is a scientific way to measure pain, but there might not be a scientific way to measure pain in a person using an MRI or something. Subjectively,
[00:20:57] Simone Collins: like... Oh, wait. How does the bug thing work?
[00:21:01] Malcolm Collins: Okay, I’ll look it up while you
[00:21:02] Simone Collins: talk. ‘Cause I go into a doctor’s office and they’re like, “What level of pain do you have, one through 10?” But then if they think you’re, like, trying to get opioids or something, they’re like, “Mm, I don’t know about you.” And I, yeah, I mean, like, I, I know, I know people who have dealt with chronic pain throughout their lives, and- Okay,
[00:21:21] Malcolm Collins: yes, it’s called the Scoville system.
[00:21:23] Simone Collins: Okay, tell me how this works. It,
[00:21:24] Malcolm Collins: it was cr- it’s, it’s a Schmidt sting pain index, created by entomologist Dr. Justin O. Schmidt. It ranks the relative pain- That
[00:21:31] Simone Collins: is an autist
[00:21:32] Malcolm Collins: if I’d
[00:21:33] Simone Collins: ever seen one ...
[00:21:33] Malcolm Collins: of insect stings from ants, bees, and wasps on a numeric scale, much like the Scoville scale ranks the heat of chili.
Okay. How it works: one to four rating. The scale runs from zero, completely harmless or ineffective against human skin- Okay ... up to four, excruciating, incapacitating pain. Each whole number step up is roughly tenfold more painful than the next level. Firsthand testing, Schmidt cataloged the data by intentionally allowing himself to be stung by more than 80 species of insects over his career.
[00:22:00] Simone Collins: Right, but no, that’s just giving... That’s, that’s, like, a, a s- a spiciness meter. It’s the number of chilies on your menu. That’s not allowing a doctor to objectively be able to tell if a body in front of him is, is in pain or not. I mean, like, maybe they’re screaming and writhing, but, like, you don’t know if that’s acting or if that is real as, as, as, a, a third party.
There’s no way
[00:22:24] Malcolm Collins: to, like- Geez, looking at some of these insects, they can really do a number on you. Oh
[00:22:27] Simone Collins: f- okay, anyway. Sorry. The bullet ant? Hey, Frank, I need to get de-miked. Can, can we pause for a second?
[00:22:31] Octavian: Right, if the diagnosis was correctly made.
[00:22:35] Simone Collins: Oh. Anyway. So the way that, like, doctors put the, the Lazarus sign, they’re like, “Well, I mean, you know, because the, the arms appear to reach toward the face or tube, people sometimes describe it as trying to pull out the tube, or sitting up, or fighting the surgeon
which can be deeply unsettling to see, and it deserves a clear explanation before family members witness withdrawal of ventilation or donor surgery But that sounds awful dystopian and kinda like we need an explanation for these people who just- That is the most dysto- and
[00:23:13] Malcolm Collins: th- this is all coming in the context of I understand that organ donation saves lives,
[00:23:19] Simone Collins: but- And I know that’s where it feels super tricky about this
[00:23:20] Malcolm Collins: we need a better system for doing it than this. And we
[00:23:23] Simone Collins: need- Well, or at least to be like, look, ‘cause I think, you know, there’s a lot of people who are like, “If I’m damaged goods, I don’t, don’t bring me back. Like, I lived a full life. I’d love to do some good if, you know, I don’t wanna live the rest of my life severely disabled.”
‘Cause that’s, I mean, that is often what happens to to people who are declared brain-dead after a l- so, you know, it, it, and, and it is true that many, many patients who, who are declared bain- brain-dead don’t make it, even if they last for a really long time. So the paper I actually referenced when looking up the Lazarus effect, there’s this academic paper that specifically reported on two brain-dead patients who survived [00:24:00] for over 100 days after being declared brain-dead.
They note in the abstract of that paper that while typically someone who is declared brain-dead dies of some form of, like, cardiac arrest or, like, they just, their heart fails after a week. One was, like, they survived for, like, 117 days, and the other one survived for longer. And both had showed these Lazarus signs during that process.
And the paper does also note that organ donation was recommended to both families, but both families refused. So, I mean, good on them, but also, like, th- there is that conflict of these Me- very often people who do get this bad don’t survive. But then we have that, like, mm, like you said, like, you’ve heard of people in the medical profession who are like, “Yeah, sometimes we just won’t really bother to do this all the right way.
We’re not really properly diagnosing. We’re kind of triaging a situation, and it’s just easier for someone to be brain-dead than for us to have to work on them a whole lot more when, you know, I could save, spend
[00:25:03] Malcolm Collins: my time-” Well, I mean, I think that, that, that my take would be that we just need a lot more research into how to tell if somebody actually isn’t gonna come back, and that is just not something that there’s a lot of motivation for right now.
[00:25:14] Simone Collins: Yeah, yeah. Because the, the money is in favor of funneling toward organ donation. Anyway, also sh- she’d mentioned the apnea test, so we’ll take a look at that. In the apnea test, what clinicians do basically is if someone, if you’re on oxygen support, they, they will s- get you to 100% in, in, like, your blood oxygen, and then they’ll just turn it off.
And what they’re trying to see is within this 10-minute window, if when your oxygen concentration goes down whether you will take a voluntary breath. And what my friend had said was, like, well, that, you know, like, th- they use this as part of maybe a classification for someone is brain-dead. But if someone is extremely sedated or on a bunch of other meds, look, they’re, they’re probably not gonna breathe on their own because they’re so-
[00:26:06] Malcolm Collins: Th- like, any sedated person is brain-dead for them.
Like, they’re just like-
[00:26:09] Simone Collins: Yeah, like, they could be pharmacologically paralyzed ... anyone you took to a hospital and put in this
[00:26:12] Malcolm Collins: situation would be in that situation.
[00:26:15] Simone Collins: So I look it up because when, when, when I first looked around it was like, well, that would never happen because current US guidelines specifically require that sedative effects and pharmacologic paralysis should be excluded and not present before the test can support a brain death determination.
But then I, I was like, well, okay I, I, y- these guidelines are not enforced. We actually can’t know with certainty that every US hospital or even every clinician in every case follows these 2023 guidelines around this test exactly. The guideline is a national professional standard. It, it’s supposed to improve consistency.
It’s not a law. It’s not like a, a hospital policy. And so there’s nothing technically in most cases, though there may be states where there actually are hard laws about this, not that I found- Mm-hmm ... while I was researching this though that say, like, you have to, like, make sure everything’s completely out of the system before you run this test.
However, there doesn’t seem to be a whole lot stopping people. Let’s go to the, the mentions of, of, like-
[00:27:20] Malcolm Collins: Well, I mean, one of the things to remember here is hospitals are systems.
[00:27:24] Simone Collins: Yes.
[00:27:24] Malcolm Collins: And there is a huge incentive for these people to die. And in addition to that huge incentive, there’s a huge incentive for them to not realize or not take moral culpability if they’ve been making a, a mistake here.
And on top of all that, there is a, a huge financial incentive because you’re not gonna get another job easily if you, if you whistle-blow on this. Yeah. And then on top of all that they believe that they’re probably doing the right thing because they’re saving more lives than they’re taking.
[00:27:54] Simone Collins: Like, they would- Yeah, and I mean, these are, again, like, these are cases where it’s, like, look, th- their odds of surviving are so low.
And I... These [00:28:00] are also often probably clinicians who are like, “I know this kid who needs a kidney so bad,” you know, this, this, this. And they’ve gotten to know them probably over time, I bet- Mm-hmm ... you know, if, if, if they’re- Yeah ... working in hospitals. And so, like, you know this kid. They’ve been on the list.
Like, they could die. They’re so sweet. You have a relationship with them. And then here comes in this stranger who had a drug overdose, and you’re like, “Who’s this,” you know, like, “jerk?” You know, like, what? There are, like, you know, someone comes in and, like, you know, they’re in their 30s and they’re a parent or whatever, but they just had a car accident.
Well, they’re probably dead, and it’s really busy, and who knows if we could even save them now, so it’s just better to declare them brain-dead, blah, blah, blah. So I get it. Like, it is, it is an ethically fraught situation. But from a personal standpoint, like, whoa. Anyway, it’s not just about what, like, this, this moment of triage.
It’s also about what happens to these live bodies. And that’s kind of where I have the problem with it. I’m like, okay, it’s one thing for, like, a doctor to be like, “All right, Simone, she looks pretty wasted. Like, she got really messed up in that car accident or whatever. Like, let’s just dec- declare this an organ donation situation.”
Look, if you’re gonna do that, if you’re gonna harvest my organs, I wanna be, like- I want the pain meds. I want the pain meds that are gonna work, okay? Like, I, I, and, and also, I didn’t know that, that a lot of other things can happen. So yes, there, there have been studies in which genetically modified pig kidneys were connected to or transplanted into brain-dead research patients.
There... You can see. I, I, I’ll link to it in the show notes, this, this study. Human brain-dead recipient model in solid organ xenotransplantation: a scoping review of technical and ethical issues. Hey, Mommy,
[00:29:39] Octavian: what are the chances of a tornado?
[00:29:42] Simone Collins: Very low. I saw that there was gonna be a little bit of rain around 3:00 PM and then clear for the rest of the evening, so you’re all set, buddy.
Now we’ve got to finish this up, and then I’m gonna go cut your hair, okay? Okay. Okay. I love you, buddy. Go, go do some chess strategy learning or watch something else educational or do lessons even better, okay?
[00:29:59] Octavian: Okay.
[00:30:00] Simone Collins: Okay. I
[00:30:00] Octavian: tried to go in your
[00:30:02] Simone Collins: room. Okay. I love you, buddy. I love you so freaking much. You, you be good.
He’s- Okay ... he’s doing his, his normal, his normal thing. Oh, he’s gone now. Okay. Close the door please.
Door? Okay, whatever. I don’t care. Where were we?
Right. So anyway, you can see that study, and it’s all about pig kidneys on organ donors. Also trainees can absolutely participate.
[00:30:35] Malcolm Collins: God, imagine a Muslim gets that. I can see why the Muslim man was so freaked out. Oh,
[00:30:40] Simone Collins: yeah, no kidding. I think it had to do more with burial, but you’re right that the, the pig kidney thing might be
[00:30:46] Malcolm Collins: a little- Yeah, wait, for Muslims, they need their body intact.
Remember our episode on the Muslim afterlife.
[00:30:49] Simone Collins: Oh, that’s it. Yeah, so it was about that. But yeah, anyway, the, the pig kidney thing would just add insult to
[00:30:55] Malcolm Collins: injury. One of our best videos, by the way. I strongly recommend it.
[00:30:57] Simone Collins: It’s a good one. It’s, it’s a very good one. It’s crazy
[00:31:00] Malcolm Collins: what Muslims- It’s- ... believe about the afterlife.
[00:31:04] Simone Collins: Yeah, and then even the additional things we learned in the comments, like, “Well, and you can see their shins through their legs, and their eyes, or...” Anyway, ooh. Ooh. Okay. Back to brain-dead. Where-
[00:31:15] Malcolm Collins: Yeah, she’s talking about the sex slaves they all get in the afterlife.
[00:31:19] Simone Collins: Yes, the virginal companions.
[00:31:23] Malcolm Collins: If you haven’t seen that one, for a bit of a teaser-
I would get at least one extra wife. All Muslims get at least one extra wife.
[00:31:30] Simone Collins: Yeah. Yes, this is true. I mean, you would get more. You’ve been so great. So I’d have to, I’d have to compete, but I wouldn’t feel bad about it, because that would happen to me if I make it to heaven. Though probably not, because Muhammad saw more women in the fire, and I clearly have done wrong by you telling you to go on the organ donation registry.
Oh my God. So I guess I’m gonna burn in the fire. Thanks, Malcolm. Fantastic. Anyway yeah, so, y- it’s not just that you may get [00:32:00] some kind of weird experimentation, it’s also that the trainees might operate on you, ‘cause they’re like, “Oh, what are we...” You know, who cares if you flub something a little bit.
You know, you just do the practice operation on the brain-dead patient. But then things like actual whole body donation for anatomy teaching or dissection in, in some forms of practice surgery, apparently you need to, like, sign up extra for that. I’m not really sure how that works. I don’t know. I mean, you got brains from people for things.
[00:32:31] Malcolm Collins: Yeah.
[00:32:31] Simone Collins: Schizophrenic people. Presumably those schizophrenic people were, like- And
[00:32:34] Malcolm Collins: none of them were brain-dead. They were dead dead.
[00:32:36] Simone Collins: I know. But- Presumably they said, “You can have my brain,” correct?
[00:32:42] Malcolm Collins: Yeah. Presumably? I don’t know. A lot of them were sort of like wards of the state.
[00:32:49] Simone Collins: So you were just part of this system that was like, “I don’t know where this brain came from.”
I don’t care
[00:32:54] Malcolm Collins: about taking
[00:32:55] Simone Collins: brains- “I’m just here to pick up the brain.” Whole
[00:32:57] Malcolm Collins: brain. I think it’s quite different to take body parts from a dead person-
[00:33:01] Simone Collins: Yes, this is true ... than
[00:33:01] Malcolm Collins: taking body parts from
[00:33:03] Simone Collins: a not dead person. No, 100%, yeah. Yeah, yeah, yeah, yeah. No, that’s true. That’s true. I mean, I prefer to be turned into diamonds, so I want all of that carbon so that all of my children can wear a bit of dead mommy.
But you do you. We really need to buy a diamond compression machine ‘Cause they’re just individually so expensive. This is what you’re gonna have to use my life insurance to buy, and you’re gonna be very angry about.
[00:33:26] Malcolm Collins: The, the diamond machine? Yeah. And then I’ll sell them? We’ll make it a techno puritan thing.
Oh
[00:33:29] Simone Collins: my God, yes. And everybody get to be a diamond. See, you could sell them, so it’ll have an ROI. Buy a piece of, buy a piece of history. It’ll be great. No,
[00:33:38] Malcolm Collins: for other people. You make it like a techno
[00:33:39] Simone Collins: puritan funeral, right? Oh, right, right, right, right, right, right. Oh yeah, never mind, yeah. So yeah, you can just keep mine for the family jewels.
That, come on. How cool would that be if the family jewels- I love you’re
[00:33:49] Malcolm Collins: like on Alibaba, buy a machine for turning dead bodies into diamonds I
[00:33:53] Simone Collins: found some. They look legit, and I mean, it’s such a big industry now. I, I don’t think there’s,
[00:33:59] Malcolm Collins: you know- It’s not an industry I’d have fun working in if I’m going to be honest.
I don’t want dead bodies showing up at the house.
[00:34:05] Simone Collins: They’re not... They’re ashes. They’re not gonna give you the thing, the, the meat part. They give you the burnt part. And we had my mom’s ashes sitting in our house for the longest time before you found the perfect tree, and that was very thoughtful of you.
Thank you.
[00:34:21] Malcolm Collins: The tree’s doing really well, by the way.
[00:34:22] Simone Collins: I know. You’re the best. You really are the best. Anyway, think about it, Malcolm, okay?
[00:34:30] Malcolm Collins: I’ll think about it. I’ll think about it.
[00:34:32] Simone Collins: Right? We’re burning me.
[00:34:33] Malcolm Collins: I’ll do a GoFundMe when you die.
[00:34:35] Simone Collins: Oh, you’re not even gonna use the life... Well, I guess you probably are not allowed to use-
[00:34:39] Malcolm Collins: No, I, the life insurance,
[00:34:41] Jerry: I’m gonna use that on the kids.
You crazy?
[00:34:42] Simone Collins: No, that’s true. The, never mind, you’re right. Ah, what was I... Yeah, no, honestly, like that, the only reason I don’t wanna die is ‘cause I, I need the, I need to take care of you and I need to take care of the kids, and that is, is why. Life
[00:34:53] Malcolm Collins: insurance isn’t a windfall. I’ve got a date.
[00:34:56] Simone Collins: Oh, great. Right. Of course.
Anyway, moving on let’s get to the business of organ harvesting, and I think this is where it sort of is like, like a lot of this could just be well-intentioned people trying to do their best. It, it gets a little messy sometimes. It becomes a problem when there’s a systematic need for organs. So just to set the scene, broad hospital operating margins are really thin.
This organization called KFF, which is linked in the show notes, reported a national average hospital operating margin of 5.2% in 2023. Mm-hmm. And then more recent non-profit system reporting found a median 1.5% operating margin in 2024. And in that environment, managers are going to care about every reimbursable activity.
And even if it’s not a central profit driver, an organ donation isn’t for hospitals. It’s, it’s, you know, it’s the, the flashy like outpatient stuff, hip replacements, et cetera, [00:36:00] whatever, right? Like the, the kind of routine, easy stuff that they can just kind of make a lot of money on, and they can just run people through.
But- Organ donation is one of those things where you can kind of turn a situation that would possibly be even be a negative into a positive. And so there, there isn’t any single trustworthy national figure for hospital profit per donor ‘cause hospitals don’t separate out organ donation as like a line item in their financials, which I think they should.
But Medicare reported roughly 3.3 billion in claimed organ acquisition costs in 2016, and reimbursed around 1.6 billion. That is to say 48% as its share. And a more recent policy discussion reports that, Basically, 2024 data in which non-renal organ revenue exceeded non-renal acquisition cost by 100 million, which shows some kind of system level possibility of over-recovery in a specific reimbursement category.
And I don’t know why they’re separating out renal and non-renal organs. Maybe you do, but whatever. It-- There are, there are financial incentives, especially when the margins are that thin, and that makes me worried. So it’s, it’s clear that basically any large transplant center with substantial Medicare organ acquisition activity is gonna receive a very meaningful reimbursement through its Medicare cost report.
And if you have a high-performing donor hospital, it, it could really improve not just its own economics, but then this economics of this whole affiliated organ transplant organization ecosystem, which could be putting pressure on doctors. There’s-- I found one 2019 conference abstract using fiscal year 2016 Medicare cost report data that estimated that each organ procured for an one of those organ, like, organizing operations increased average Medicare organ acquisition reimbursement by roughly $10,918 per kidney, 11,291 per liver, 11,371 per heart, 9,294 per lung.
And if you add all those things up, like one human that has a decent kidney, liver, two, two lungs, and a heart, that can-- Y- that’s, that’s a decent amount of money. Anyway for the standard transplant programs, the estimated average annual increase in Medicare reimbursement attributable to procurement was approximately 460...
Sorry, 456,000 for kidneys, 593,000 for liver programs, e- 383 for heart, et cetera. Anyway, these are reimbursements. They’re not the net profits. But also, like, I don’t know how much in terms of incremental costs you have for things like organ extraction at a hospital. I mean, presumably you have, like, your doctors who are on call.
Like, y- you’re paying your s- your s- salaried staff to do this stuff. And I would probably, if I were the hospital, have a brain-dead patient scheduled for organ transplantation. Like, I would just- Mm-hmm ... fit them in to unscheduled spots, right? And then of, like, slow times ‘cause you can just kinda keep them alive as long as you want, like, within at least a week before they’re very likely to die, and then you just slot them in.
So I don’t think the marginal cost of processing people for organ transplantation costs hospitals incrementally that much more. So as far as I’m aware, as far as I can figure, it’s just upside Anyway, this
[00:39:45] Malcolm Collins: is what I have to do Isn’t that great? Every day you get potential organs coming through your door
[00:39:52] Simone Collins: I mean, if I were a hospital administrator, I would have a difficult time seeing it as anything other than that, wouldn’t you?
If you’re that concerned. Yeah. If you’re running at a [00:40:00] 1.5% margin-
[00:40:01] Malcolm Collins: Oh, absolutely.
[00:40:02] Simone Collins: Yeah ... that’s so thin. I mean, you are definitely chewing people out for not-
[00:40:06] Octavian: Mom, can I have... I want some of the spicy popcorn.
[00:40:08] Simone Collins: Friend, I... Whoa, why do you smell like barbecue? Buddy, you eating chips. Why am I gonna give you more junk food if you’re just already eating junk food?
Friend, I’m gonna be down in about 10 minutes. Can you give me time until then, please? I love you. And off he goes. Anyway, we need to get you off the organ do- donor registry. We need to get me off the organ donor registry, and I’m just gonna, I’m gonna go through first a scary case of the, the Muslim convert, and then we’re gonna talk about how to do it.
So this was actually in 2026. It... This is a man in New Jersey named Keith Lott. He, he previously registered as a donor through his New Jersey driver’s license, just like we all do. For those of, who are outside the US, when you get a driver’s license in the United States, they ask you on your little form, “Would you like to be an organ donor?”
And on your driver’s license, if you are an organ donor, you have a little heart, a little cute red heart. And if you see someone’s license that doesn’t have the little red heart, you just know that they’re a jerk, a selfish jerk who doesn’t wanna save that poor Jimmy who just needs a
[00:41:17] Malcolm Collins: kidney. What you said to me.
[00:41:19] Simone Collins: There’s a lot, there is like, there is genuine social pressure around it. Like, if someone’s looking at your driver’s license and they, you know, believe in helping kidney, heart transplant, whatever, like vulnerable people get the organs they desperately need, they, they’re gonna judge. And also keep in mind, the effective altruist community’s pretty famous for donating kidneys like going out of their way to give organs.
Of course, they’re all gonna register as organ donors too. I
[00:41:47] Malcolm Collins: mean, I think what we should do is make it legal for living people to donate organs for money.
[00:41:52] Simone Collins: For... No, like actually. I, I think that that’s super important. I, I wish that that were the case because it would make things, I think, in many ways, more ethical.
You could make constraints for it. Look, you can set, you know, if this person is impoverished, then they can’t, or whatever. I don’t care. But like make it- Or
[00:42:08] Malcolm Collins: pre-sell your organs if you reach a certain state of health.
[00:42:13] Simone Collins: Daddy, you- Oh, like if you’re not healthy enough, you can’t sell them?
[00:42:16] Malcolm Collins: Did you set off a mousetrap?
[00:42:18] Octavian: No. I just- Not at all. You had a call before.
[00:42:22] Malcolm Collins: Oh, I did?
[00:42:23] Octavian: Yeah. Yeah,
[00:42:23] Malcolm Collins: it looks like spam
[00:42:26] Octavian: What’s spam?
[00:42:27] Malcolm Collins: What’s spam? Spam means it’s a random person that really didn’t wanna reach me. They were just trying to sell me something. It’s like a scam.
[00:42:35] Octavian: Okay.
[00:42:36] Malcolm Collins: Hey, thanks for helping.
[00:42:38] Octavian: Yeah,
[00:42:49] Simone Collins: you’re welcome. I thought it was someone important. Aw. We’ll be done super soon, Octavian. Okay, okay. Oh, good lord. Anyway, so after he converted to Islam and did not reselect his donor option in 2025 He finds himself very tragically on life support, and representatives connected to the donation process told his family that his earlier registration was a lifetime contract.
And p- reporting of this case says that his-
[00:43:14] Malcolm Collins: Nobody told me that when I ticked a freaking box. And did you know that the main thing that effective altruists have talked about when I’ve talked to them in their meetings is making it the default when you sign up for- Yes.
[00:43:25] Simone Collins: Yeah, yeah, yeah, yeah. Yeah,
[00:43:26] Malcolm Collins: And if they’re gonna treat it as a lifetime contract and it’s the default option on a long standardized form, that is wildly unethical.
That just makes me hate these organizations.
[00:43:37] Simone Collins: Oh, so hold on. Hold on. There, there actually is no legal basis in New Jersey law for the claim that a donor registration cannot be revoked during the donor’s lifetime. And allegedly- Oh, in New
[00:43:47] Malcolm Collins: Jersey law. What about Pennsylvania? What about any other state?
[00:43:50] Simone Collins: I, I know. I know, I know. We all have to look this up. But allegedly, the New Jersey sharing network reportedly said that it accesses Motor Vehicle Commission donor status [00:44:00] information in real time to verify the most current status, but what appears to have happened is the organ procurement organization was using outdated records and then just lying about them.
This whole lifetime con- they just made that up. They’re like, “Look, his name’s on the list. We’re, we’re taking his organs.” And so his family had to, to seek court intervention in this very time-sensitive conflict in order to stop the process. So another element of this that concerns me isn’t just, like, oh, is the person actually brain-dead?
Did you actually get the diagnosis right? It’s also, did this person actually consent to this? Like, are you, are you even checking up-to-date records? What if they changed their mind because they saw this episode? I don’t know. Mm-hmm. But what you need to do if you want to change it is first, if you’re in the United States, go to your DMV state website and-
[00:44:59] Malcolm Collins: Are you gonna book time for this?
Or are you gonna handle this
[00:45:02] Simone Collins: for me? Yes. I a- I am going to handle this for you, Malcolm. Yes. I obviously got you in this problem. I’m going to get us out of it. But you, you have to first make sure your license doesn’t have that designation, and then you need to make sure that when you change the designation, that you print and keep the receipt.
Then you need to make sure that your friends and family know that you’re not an organ donor. So you have to very openly broadcast, and they’re gonna criticize you, and you’re gonna have to push through and just send them a link to the show notes that we have on Patreon or Substack.
[00:45:31] Malcolm Collins: Well, no, our friends and family know- You’re not gonna tell all of them
because our fans know, okay?
[00:45:36] Simone Collins: Okay, fine. But who’s gonna be at the hospital? And you
[00:45:38] Malcolm Collins: know we’re gonna be telling my brother about this.
[00:45:41] Simone Collins: I’m su- yeah. Yeah, I was gonna say I’m sure he’s not, but he probably would’ve said, “Yeah, I’ll, I’ll do it,” you know? ‘Cause he’s such a nice person too, and like, ugh, God. Anyway, make sure that the people who are gonna show up at the hospital if something bad happens to you know that you’re super not cool with it, and then a very strong practical measure on top of that is to add a direct statement to your advance directive or healthcare power of attorney that’s something like, and I have this written down in the show notes, “I revoke any prior anatomical gift, organ donor registration, tissue donor registration, eye dono- donor registration, whole body donation, and authorization for post-mortem research and education.
I do not authorize the recovery, donation, transplantation, therapy, research, education, training, or other use of my organs, tissues, eyes, or body after death. My healthcare agent and family are directed to communicate and enforce these wishes.” So I don’t know. Consult a lawyer. This is not legal advice, but Don’t show up to stuff without documented not f- no, no taking, no touch.
I would, I would appreciate if you all did that. But then of course I feel conflicted because, like, if you’re actually donezos you know, if you wanna give your organs. I, I feel so- Yeah ... but also I, I, I don’t wanna, I don’t wanna be brain dead, but also maybe not brain dead and maybe feeling all the pain as they harvest my organs, so I don’t know.
Where are you with all this?
[00:47:15] Malcolm Collins: I mean, I think this is horrifying. I can’t believe that you... This whole Lazarus effect thing, the way that they word it, I’m sure it- Subreflex ... in part a real effect and-
[00:47:26] Simone Collins: I’m sure ...
[00:47:27] Malcolm Collins: something they say to sleep at night, you know?
[00:47:29] Simone Collins: I’m sure. Yes, both. I mean, well, so here’s, like, where I have a problem with it.
They’re like, “I mean, it’s impulses in your spinal cord,” and I’m like, yeah, but it’s also, like, maybe this is due to my very poor understanding of biology, but it’s, you know, like, impulses in my spinal cord, et cetera, that, like, cause me to feel things.
[00:47:48] Malcolm Collins: And you- Yeah, impulses. That is true. That is how-
[00:47:50] Simone Collins: So- ...
[00:47:51] Malcolm Collins: your entire nervous system works, is impulses in your spinal cord.
[00:47:53] Simone Collins: Yeah. You know, that’s being like, “Oh, it’s just your pain receptors firing. Like, don’t worry about it.”
[00:47:59] Malcolm Collins: And I’m like, “Hmm.” It has [00:48:00] to do with how complicated the motion is, and I’m sure there are some simple, you know, like, you cut a snake in half and the bottom half is still writhing, right? Like- Uh-huh
simple actions that are just happening because of the spinal cord, but a lot of it doesn’t sound like that. A lot of it sounds like they understand that, that, like, we’re doing something, we just don’t care. Like, that’s what I’m getting from this. I’m glad you brought this up. I’m glad we did an episode on this.
[00:48:26] Simone Collins: I’m glad my friend told me about it early in the morning.
[00:48:30] Malcolm Collins: So, guys, please, please, please check out rfab.ai. It is our AI website. I really want to share this with you guys, with the world- It’s amazing ... and use. It is the best AI chatbot site in terms of allowing you to use frontier multi-window models, which is just, in, in terms of technology, if you compare it to something like Janitor AI or, you know, ChatGPT or, you know, FlowGPT and, like- Well, I’ve actually...
[00:48:55] Simone Collins: An important note. I’ve heard a lot of companies advertising, like, “Oh, well, you just need one place where you can switch between, you know, one thing and the other instead of paying for all the subscriptions separately. This is much more affordable.” The problem with them is that they are In this case, for-profit companies that are not run by people who are just really nerdy about them and they need to make money.
And like, I guess we really do need to make money. We’re just very bad at it. And so you, you charge much less of a margin, right? The indus- industry standard for charging-
[00:49:27] Malcolm Collins: Is four, well it’s three to five x is the industry standard. Are you serious? And we charge 50%. Yeah.
[00:49:32] Simone Collins: Right. So we are charging, like in terms, like if you
[00:49:34] Malcolm Collins: actually- Oh, oh, sorry.
We don’t even always charge at 50%. Yeah. If something is a stable price and large, like video production, ‘cause that’s very costly we charge half that.
[00:49:43] Simone Collins: Sometimes I feel like we’d be operating on hospital margins, my friend. I mean, especially when you add in like the, the vibe coding expense, we’re op- operating on what?
Much worse than hospital margins right now.
[00:49:52] Malcolm Collins: Well, we’re operating on negative margins, but we’ll be dead soon. We’ll
[00:49:54] Simone Collins: be dead soon. Extremely negative margins. But I would say from that perspective, like if you remember the days of like startups offering extremely inexpensive but high quality services, because they were basically subsidized by VC money, we’re the equivalent of that except we’re subsidized by like Malcolm’s intensely laborous volunteer labor.
And our, I don’t know, pathological inability to-
[00:50:23] Malcolm Collins: Well, a lot of people will be like- ... take money ... “Then why aren’t you more expensive than my other site?” And it’s like, because we use frontier models. You’re like freaking Jerry in, in a, in a simulation set at 5%.
[00:50:33] Alien: Well, cap his sector at 5% processing, keep his settings on auto, and we’ll deal with him later.
Rick Sanchez is the target.
[00:50:39] Jerry: National Apple Farmers of America. I give you your new slogan.
[00:50:43] Terrified Man: Yes.
[00:50:44] Jerry: You do? Yes. So I sold it?
I sold the idea? Yes. Oh, my God. Thank you.
[00:50:53] Octavian: You
[00:50:53] Jerry: are
[00:50:53] Malcolm Collins: welcome. And when she said that’s all of the stuff, it is all of the stuff. We give you all of the options for image generation. We give you all of the options for video generation. We give you options for putting an image here and then, like, a line here.
That’s, like, the layout thing. It’s the, the new feature. We are working on better image generation. No,
[00:51:12] Simone Collins: that’s... Bruno pointed that out, right? I- thank you, Bruno. We
[00:51:15] Malcolm Collins: appreciate that. Yeah. We are working on the- our 3D generation- Music ... is pretty good. The, the rigging system is pretty good. Our little puck, you know, offline system for giving it to your kids for educational purposes is pretty good.
You know, we’ve got, like, you dump a document in, it’ll turn it to audio so you can listen to it. We’ve got audio to audio. Base AI yesterday had a hiccup where it didn’t work for part of the day, and it was shunting to OpenAI. I am so sorry. I didn’t know the AI had built it that way. I fixed it. Now, if it’s ever broken, it’ll just tell you.
It’s back to working now, so don’t worry. But, like, the, the roads model’s fantastic for, like, super base stuff. Just, you know, all of, all of these cool things you can play with. And it is, it is meant for chuds. You know,
[00:51:58] Simone Collins: that’s the- It, it is really good. It’s, it’s genuinely really, [00:52:00] really good. Oh, you...
Also anime dubbing. You forgot that. But not just anime dubbing. It’s like, because it’s... This is all from a, such a, an enthusiastic and genuine perspective on Malcolm. Like, Malcolm didn’t just want anime dubbing and, like, generic AI voices. The accents come through. It’s insane. Like, if someone’s supposed to be a hick, they’re gonna sound like a hick.
Which I do not know how that, that works. It seems like magic to me. I know it’s just technology I don’t understand, but I really like it.
[00:52:27] Malcolm Collins: What, what, what hick?
[00:52:29] Simone Collins: The, the, the anime dubber. I know it’s not just anime dubbing. I guess it’s any dubbing, but how the accents come through.
[00:52:35] Malcolm Collins: Oh, yeah. It’s really cool.
[00:52:37] Simone Collins: Mm-hmm.
[00:52:38] Malcolm Collins: So that this one is- Yeah, I mean, we offer all the APIs, and I work really hard to find the cheapest ones for you guys. You know, you have the stuff we can do.
[00:52:48] Simone Collins: So check that out. Because it’s... I’m so sorry. I did not sleep very much.
[00:52:54] Malcolm Collins: It’s really good. Well, let’s let you sleep extra early today. I
[00:52:56] Simone Collins: would like that.
This has been a day.
[00:52:58] Malcolm Collins: I’m not very hungry, so I’m not gonna eat.
[00:53:00] Simone Collins: Did you eat all those chips too?
[00:53:03] Malcolm Collins: I ate one bag of chips.
[00:53:04] Simone Collins: Oh. One small bag.
[00:53:05] Malcolm Collins: Well, then,
[00:53:05] Simone Collins: Malcolm, you need to eat something.
[00:53:07] Malcolm Collins: Just not feeling it. I’ll have salsa or something.
[00:53:15] Simone Collins: You need to take c- care of you. I guess you did have a smoothie. You ate a smoothie and you’ve... No, that is not enough food. That is not a... What am I gonna do with you? Did you know that, like, in, in, in 1950s home ec classes, y- you know, a, a, a, a wife of a house was taught, basically trained as, as a, a nutritionist as well.
Like, you learned how to cook, you learned how to fix things, and you were taught about the different nutritional needs at different- Mm-hmm ... ages for different people, different levels of activity. And it is my task, even though our society has completely dropped those lessons-
[00:53:52] Malcolm Collins: Nutrition ...
[00:53:53] Simone Collins: to be concerned about your nutritional needs and a balanced diet.
[00:53:58] Malcolm Collins: And when I just say for a few days when I’m grieving, “I’m sorry, I don’t feel like eating,” you think I’m gonna die?
[00:54:03] Simone Collins: Yeah. Well, it’s been several days now. And, and I mean, it was one thing when I told you, and then you, you couldn’t eat, and then another day passed, but now it’s been, like- Five days? Mm. So maybe we can take better care of
[00:54:21] Malcolm Collins: ourselves.
I’ll survive.
[00:54:22] Simone Collins: Mm-mm.
[00:54:23] Malcolm Collins: Simone, it’s important that we act happy for the fans and that we put on a, a good, a good act so that we got, we got cheerful, fun episodes for everyone, everyone having a good time. Yeah, yeah, yeah. At least I have my alcohol, you know? I, I, I, I still like that.
[00:54:45] Simone Collins: It’s not great. I love you.
I love you and who you are, and I’m gonna go get you off the organ donor registry, and I’m sorry. I apologize. I was wrong. Don’t worry. And at the very least, you got a really big, fat I told you so out of all this,
[00:55:01] Malcolm Collins: so. But eventually, I think where this unfortunately needs to go is you need enough people withdrawing themselves so that they redo the way the system works so that it makes sense to be on it, right?
Like, right now I’m scared to be on it because of the way that they’re acting around this and not admitting that these are major mistakes and charging people with punishments around this. I mean, I think this should be capital punishment ar- around some of this stuff, right? Like, that, that you would... I- i- if not that, very severe jail time.
[00:55:32] Simone Collins: I mean, it’s, yeah, it’s... There, there
[00:55:35] Malcolm Collins: are issues with this too, and- The thing I don’t get is the Muslim guy, right? Like, the number of cases where somebody has taken themselves off to be that greedy about his organs is absurd.
[00:55:47] Simone Collins: Well, yeah, I mean, especially if a family’s like, if it’s not on his driver’s license, and if his family is saying, “No, he’s Muslim.
Don’t do it,” I mean, I feel like I’d just back off. But I also am aware now of [00:56:00] the institutionally in endemic pressures on hospitals and all these organizations to just like, “No, we have to, we need to take this.” Like, we are not going to be i- net- net positive at the end of the year if we do not get, like, this certain quota.
It’s very scary. So I don’t know what to do about it aside from get us off right now and we need to reevaluate later. But I would... Look, maybe this isn’t gonna matter really soon because we’re starting to grow organs from stuff
[00:56:32] Malcolm Collins: Animals. Yeah, w- stuff, which I’m, I’m awesome for. You
[00:56:36] Simone Collins: know? I’m awesome for. Yes, stuff.
Stuff based organs which of- I want
[00:56:41] Malcolm Collins: more stuff based organs for
[00:56:43] Simone Collins: my- Let’s get the stuff based organs ...
[00:56:44] Malcolm Collins: my immortality.
[00:56:45] Simone Collins: You can just shove in another, an extra one. You know, just have two hearts. Why not? A backup heart. I want
[00:56:51] Malcolm Collins: all the organs. I will be a, a, a time Lord. I
[00:56:53] Simone Collins: will have two
[00:56:54] Malcolm Collins: hearts.
[00:56:55] Simone Collins: Shove them all in.
Doesn’t he have four?
[00:56:56] Malcolm Collins: I think he has two, but it, like, wouldn’t be efficient. It’s a bad way to do it. You can see he has extra valves or something. He had
[00:57:02] Simone Collins: two hearts. Didn’t didn’t brachiosauruses have two hearts? They had the butt heart.
[00:57:08] Malcolm Collins: Right.
[00:57:08] Simone Collins: And the head heart.
[00:57:09] Malcolm Collins: That makes sense for a giant animal.
[00:57:10] Simone Collins: I mean, oh, no.
Was it the brain? There’s a butt brain and a head brain.
[00:57:14] Malcolm Collins: Maybe, but I don’t know. You, you- Whatever ... you need to go make the kids dinner and get to bed extra early, and I’m gonna come down policing you to make sure you do.
[00:57:22] Terrified Man: Thank you.
[00:57:23] Malcolm Collins: Which means I will beat you senseless if you are still down there past 6:30, okay?
What? And, oh, I’m not allowed to say that to my wife. Oh, I thought this was America. I thought this was America. What is this,
[00:57:39] Terrified Man: a communist country or something? I thought this was America.
[00:57:42] Simone Collins: Oh, my goodness gracious.
The world is so strange. I don’t know what to do. Okay, bye. Merry Christmas. Bye.
[00:57:55] Malcolm Collins: Oh, Substack. If you like weekend episodes, check us out
[00:57:58] Simone Collins: Also all the stuff’s linked, all the weird research Page
[00:58:00] Malcolm Collins: young. Yeah. Oh, yeah, yeah,
[00:58:01] Simone Collins: yeah. Yeah Xenomorph something something You add that. Yeah, whatever. The mic? Yes.
That’s my fetish.
[00:58:10] Malcolm Collins: Why?
[00:58:11] Simone Collins: I don’t know. It’s just, there’s something really cute about the sound of you chewing to me, and I don’t know.
[00:58:17] Malcolm Collins: Everyone else says, like, “That’s when I started hating him.”
[00:58:24] Simone Collins: You’re not chewing into the mic. This is for me. You’re not putting this in the podcast. Just only for- Oh no, I
[00:58:30] Jerry: am. I’m putting your weird fetish
[00:58:31] Simone Collins: in the podcast. Malcolm, you are going to anger people. No one wants to hear anyone eating or slurping, but for some reason I also
[00:58:38] Malcolm Collins: like- But they wanna see you acting like a freaking pervert with your weird ASMR nonsense.
[00:58:44] Simone Collins: I just like the sound of you chewing. I don’t-
[00:58:46] Malcolm Collins: Now, hold on, Simone. Yeah. So this is what the team told me.
[00:58:49] Simone Collins: Okay. And
[00:58:49] Malcolm Collins: I was like, I do not believe this, okay?
[00:58:52] Simone Collins: Okay.
[00:58:52] Malcolm Collins: But they had it confirmed with multiple people, so we’ll see.
[00:58:54] Simone Collins: Confirmed with... Okay.
[00:58:57] Malcolm Collins: That having designer babies is now a status symbol in, like, upper class New York circles.
Oh
[00:59:05] Simone Collins: yeah, The Economist basically endorsed it, and now it’s okay. It’s chic. What? Because The Economist endorsed it, yeah.
[00:59:10] Terrified Man: What? Yeah, actually. So we started this thing and now everyone-
[00:59:13] Simone Collins: We didn’t start it. Oh my God, though, did we? Because what if it was Barclay Bram, who works at The Economist, chilled with the cool folks at Natal Con.
We got Thai food together. Maybe he was like, “Yeah.”
[00:59:26] Malcolm Collins: Yeah.
[00:59:26] Simone Collins: Okay?
[00:59:27] Malcolm Collins: What the heck?
[00:59:28] Simone Collins: They may be hipster eugenicists, but they’re not the most evil people. I don’t know, ‘cause we’ve, like, tried to be helpful to him over time occasionally. Maybe that’s the connection.
[00:59:38] Malcolm Collins: That’s how you win, if you just be nice. Oh, we’ve gotta connect him with Yuki Jaru.
You should have her email. We
[00:59:44] Simone Collins: did already. We did. Oh, we did. Good, good, good. We did on Friday. That is so... Yes, no, I’ve, I’ve, I- I had, like, I had that as sort of, the theosophical
[00:59:54] Malcolm Collins: episode topic- What about our friend who
[00:59:55] Simone Collins: was canceled? But no one’s there. Has she said she’ll talk with him? Which
[00:59:57] Jerry: one?
[00:59:57] Malcolm Collins: For b- the trans comments.[01:00:00]
Going to SlutCon?
[01:00:03] Simone Collins: Oh, I need, I need to ask. I need to ask, sorry.
[01:00:06] Malcolm Collins: Please do. It’s, it’s narratively very important.
[01:00:08] Simone Collins: I, yes. I need-
[01:00:10] Malcolm Collins: I want to show how we win. We win- Well,
[01:00:12] Simone Collins: I was, I was waiting to see how, how it plays out. I need to check in with her. Mm. So I will do so. I will do so.
[01:00:16] Malcolm Collins: And you need to explain to them, ‘cause they’re filming behind her right now, this is RFAB technology we’re using right here.
Oh, yes. We got sick of paying other people.
[01:00:25] Simone Collins: Yes. This is RFAB technology we’re recording on now. Is that good? Did I do it right?
[01:00:33] Malcolm Collins: That was not good at all.
[01:00:35] Simone Collins: No, I’m, I’m like legit really excited about what you built with this, because someone actually just today emailed us about some Chrome plugin that he created after you were like, “Simone, you can’t keep saying this word or that word,” you know, because I was reading the Andrew Tate article quotes that I was- Mm
you know, from the, from that episode on Andrew Tate. And he was like, “Well, I built a Chrome plugin,” which is actually quite clever, “that takes all the naughty to YouTube words and will just switch them to acceptable words just in your browser so that you don’t accidentally read the wrong thing,” which is somewhat clever for, like, all the YouTubers who are trying to self-censor.
But you, like, you did that-
[01:01:12] Malcolm Collins: I created a beep with an Indian head pattern that happens with our editing system ...
[01:01:15] Simone Collins: yeah, where you could just take every single word that is naughty and just replace it immediately with censorship which-
[01:01:21] Malcolm Collins: Which I think is funnier ... I
[01:01:22] Simone Collins: th- I think it’s funnier too. I think that there was this period in the ‘90s when shows just had abundant beeps in them, and they were, like, better than actual bad words.
And I think for a while then sitcoms and other comedies used-
[01:01:35] Malcolm Collins: Well, you know what show is
[01:01:36] Simone Collins: famous for adding- ... the beeps on seamlessly ... random
[01:01:38] Malcolm Collins: beeps to-
[01:01:39] Simone Collins: Yeah, like when it’s not the real word, right?
[01:01:41] Malcolm Collins: Yeah. Do you know what show?
[01:01:44] Simone Collins: A bunch of them did it, right? No, there- Which one is famous for it?
[01:01:46] Jerry: No, the, the, there, there’s this show that’s famous for doing it g- because
[01:01:49] Malcolm Collins: the family didn’t cuss- Oh
and they wanted to make them look more like redneck.
[01:01:54] Simone Collins: Okay. Who? What?
[01:01:55] Malcolm Collins: Duck Dynasty.
[01:01:56] Simone Collins: Duck... Are you serious?
[01:01:58] Malcolm Collins: Yeah. The real Duck Dynasty family never curses. And so what they would do is they would add beeps to make it look like they were cursing up a storm all the time.
[01:02:05] Simone Collins: Okay. That’s, that’s actually pretty amazing.
Why would they do that?
[01:02:10] Malcolm Collins: Because- Just ‘cause it’s more funny when that’s the thing? ... they’re progressives who have an incredibly bigoted view of conservatives,
[01:02:14] Simone Collins: and
[01:02:15] Malcolm Collins: so-
[01:02:15] Simone Collins: Oh, so they thought they weren’t rednecky enough if they didn’t have potty mouths?
[01:02:18] Malcolm Collins: Yeah.
[01:02:19] Simone Collins: Mm. Wow.
[01:02:20] Malcolm Collins: And, and, and, and normal conservatives are, like, Christians, and so they’re like- Who wouldn’t do that
“No, why would I curse?” Yeah. “I’m not gonna be inappropriate,” right?
[01:02:26] Simone Collins: Wow, okay.
[01:02:27] Malcolm Collins: But they needed to dehumanize them, so you know, you can’t, you can’t have people think, oh, maybe conservatives aren’t, you know...
[01:02:33] Simone Collins: That’s really crazy. That is genuinely crazy. Okay.
[01:02:35] Malcolm Collins: It, it’s wild how long this has been going on, but let’s, let’s get into this, Simone.
You- Yeah ... you found a fun topic for me. Okay.
[01:02:41] Simone Collins: Yeah, separate for, like, not just... So there are two ways that I can introduce this. I can just briefly introduce it, or I could just read, like, slightly edited but the texts that I was sent that made me be like, “What?” Because I was like, “What?” And I feel like maybe that would just be a good enough introduction.
[01:02:57] Malcolm Collins: I think that is a good introduction, and, I think you are a very special person Right And this is the first public podcast, ‘cause somebody’s like, “I’m so glad to see you guys bouncing back.” And I was like we haven’t recorded any since then.”
[01:03:09] Simone Collins: Yeah, well that was from the before times, and that’s why we were so cheerful and bouncy.
But anyway, okay.
[01:03:14] Malcolm Collins: You can see those teary Simone eyes right now,
[01:03:16] Simone Collins: so. Oh, God. Well, you know what? We cry for a lot of reasons, and there were a lot of... Anyway,
What did you want to show me? A video. We have to make a video. You have to make a video. Three, two, one, go. Boogie on it, boogie on it, boogie on it
Baki ani, Baki ani, Baki ani
Okay
What are you [01:04:00] doing?
