← American Thought Leaders
American Thought Leaders
How the CCP Monetizes the Bodies of Its Prisoners | Matthew Robertson
01:05:17
Loading summary
Transcript80 lines
- [00:00]
A
There's at least one instance where a hospital and a work camp are literally next door to each other with a crematorium.
- [00:09]
B
In 2005, a Chinese official publicly admitted that China was sourcing the vast majority of its organs from prisoners. The Chinese regime claims they've stopped, but have they really?
- [00:21]
A
Chinese medical publications show quite explicitly that the donor was not deceased by any medical or legal criterion.
- [00:29]
B
For over a decade, Matthew Robertson has been researching China's organ transplant system.
- [00:34]
A
There are accounts by survivors of strange medical examinations, urine tests that are repeated ultrasounds of abdominal organs, CT scans, blood tests.
- [00:49]
B
Fluent in Mandarin Chinese, Robertson is a China Program research fellow at the Victims of Communism Memorial Foundation.
- [00:57]
A
In a state like China, the medical profession does not have actual professional autonomy, like it's an arm of the state.
- [01:04]
B
He's the co author of a number of research papers on this topic.
- [01:07]
A
They created a market in the organs of their political enemies.
- [01:12]
B
This is American Thought Leaders and I'm Jania Kellick. Matthew Robertson, Such a pleasure to have you on American Thought Leaders.
- [01:23]
A
Hello. Yeah.
- [01:24]
B
You describe it as state sponsored organ trafficking. Sometimes it's called forced organ harvesting. I've described it as a murder for organs industry in communist China. Bottom line is something terrible is happening over there. And if you were to describe it to someone who's maybe skeptical or who hasn't heard about it and might find it unbelievable, how would you explain that to them?
- [01:50]
A
I think you might start with what is the standard way that organs are procured and transplanted in most countries around the world? And that is from voluntary donors to recipients based on medical need and kind of states around the world create a system that facilitates this altruistic transfer where there is, you know, a tragedy that has resulted in most typically brain death. This is in the case of vital organs, the individual is brain dead, declared so in hospital. And then there is an organization that facilitates, you know, gains permission if they weren't already a donor. And then that's the kind of transplantation that we are mostly familiar with. So at least until 2015 and probably subsequently, China's model of organ transplantation was very different. Almost the sole source of organs were prisoners of one kind or another. So that's death row prisoners, prisoners of conscience, political prisoners, in some cases simply beggars who like homeless people who were kidnapped and killed. According to, you know, PLC media reports. When I'm talking about state sponsored organ trafficking, I'm talking about state military and paramilitary hospitals who have, you know, a transplant wing and they're performing transplants. But the Organs that are obtained, procured illicitly, often by killing prisoners, and then they are distributed not by medical need, but by the ability to pay cash to the recipient. There are some private hospitals, though, those are run by surgeons as a kind of a side hustle. And those surgeons are of course affiliated with the state or they're party officials or, or they're like, you know, the party secretary of a hospital or whatever. But that's basically how China's organ transplantation system operated and almost certainly continues to operate.
- [04:18]
B
What would you say is the strongest evidence you've seen that this whole thing, which sounds almost unbelievable, is real?
- [04:27]
A
I think ironically, the strongest evidence is, is simply the utterances of Chinese officials themselves. You could look at an official statement by someone like Dr. Huang Jiefu, who was the former Vice Minister of Health and is now kind of the great eminence of the transplant system. He's sometimes called the transplant Tsar. He has admitted almost everything I just said. The idea that Chinese hospitals procured organs from prisoners, that's not disputed by, you know, the Chinese medical establishment. That there was buying and selling of organs is not disputed. Kind of where there is the dispute is the identity of the donors. That's a matter of some controversy. And then perhaps the matter of scale or sophistication or organization or, you know, systematicity, these kind of questions. I think each piece of the puzzle has like a different kind of evidentiary trail. We could think about something like the involvement of surgeons in the execution process. The evidence there is Chinese medical publications that, you know, show quite explicitly that the donor was not deceased by any medical or legal criterion at the time of the procurement. And therefore, you know, there's a violation of the donor rule.
- [06:05]
B
And you're saying they were killed by the organs being removed?
- [06:10]
A
Yes. So the heart, the removal of the heart is the proximate cause of death in those cases. That's what our paper shows. And then for other pieces, like for example, okay, you talk trafficking, so what's the evidence of trafficking? So I mean, in that case it's even more straightforward because you look at hospital websites before, they were all taken down in, you know, 2006, seven, but they're all in the Wayback Machine or otherwise archived. And they would have, you know, price lists on the website for the organs. So, okay, so they're clearly being sold. It's a pay for treatment. So it's all kind of like the transactions are cash for the organs. So there's not like a kind of. Or there wasn't at that time A kind of a state health insurance system that would cover these treatments. There's an interesting one that relates to, like, there's. There's one really interesting piece of evidence that when you kind of dig into it has so many different, really interesting implications about things we cannot observe that is, is worth like, discussing. Do you want me to.
- [07:25]
B
Please.
- [07:25]
A
Okay. This is a phenomenon called emergency transplants, emergency liver transplants specifically. So I'll explain what that means. If a patient in any country has a acute hepatic failure, their liver fail. Fails. If they do not receive a new liver within a short period of time, then they are going to die because the liver is required, it's a vital organ. And so a patient in the United States or Australia or the UK for, for them to get that organ they present at the hospital, their condition is diagnosed and the need for an organ is established. And then they're basically, they're first on the waiting list. And if in 24 to 48 hours or whatever, there is a tragedy, there is a car crash or some other incident that renders a compatible donor brain dead, and that compatible donor has already registered as an organ donor, or their family agrees for them to become a donor, then the recipient will get that liver and their life will be saved. So how do you do emergency transplants when you don't have voluntary donors? So the Chinese government has never explained that. What we know is that in 2005 they published the annual report of the liver transplant registry at the time that had like a subsection, like had a certain number of the total number of the total hospitals doing organ transplants. And then in 2006, they published this same annual report. And these have both been deleted from the Internet. And they showed, I'm not going to get the numbers exactly, but it was something like 25%. And then the other was, was close to 30%. There were that many that were emergency done on an emergency basis, and then the remainder were done on an elective basis. So if you don't have voluntary donors, this is what the government says, therefore all the organs are coming from prisoners. And yet to get a liver, you need a compatible donor who has recently died. Then you kind of have two possibilities. And then. So one is that it just so happened in every single case that a prisoner was going to be executed on that day when the need for that liver arose. And that prisoner happened to have a compatible blood type. And that prison and that hospital had some connection, so it had to be local. So the kind of the, the difference, you know, in the uk, it could be the entire country. But in China there was no computerized system for allocating organs. And so it would have to be local. So that's one. So there's like, you can see like a chain of increasingly implausible conditions that would allow, you know, that. And even then it's from executed prisoners. And the other is that they have blood typed and then killed on demand, the liver donor. And so a lot of the evidence is of this sort. There is some, you know, something that you can see that doesn't make sense in official publications. And then there are different, like inferential possibilities, like ways to explain this outcome and then.
- [11:21]
B
But they all strangely point in one direction.
- [11:24]
A
Well, so the highly implausible one in this case would be that they were death penalty and they happened to be killed at that time, blah, blah, blah. But then the kind of far more plausible one is that actually the Chinese state had blood typed some much larger number of, of donors. Because if you're going to have so many that are on this emergency basis, then you must need a larger pool from which to draw from. And that would have to be at many places nationally because there's, you know, dozens of hospitals in this, in this data set. And so what that just this one, like page in these two documents, it has these kind of like this ripple of implications about what that actually means in terms of the logistics, donor sources, you know, what must have been happening to enable that to have been reported. And then sometimes. So some of these hospitals, before there was international attention in 2006 by, no, Kilgore Matis and everything else that went on then they were saying like, we have the bodies or words to that effect, like very explicit statements that they have the donors ready.
- [12:41]
B
Right. I remember people were calling up and saying, yeah, we can set it up for you, like on the other end of the line.
- [12:47]
A
Yes.
- [12:47]
B
Which is, I mean, unbelievable when I think about it. It's been a while since I looked at that data, that evidence, by the way.
- [12:55]
A
But yeah, I think people just don't believe the phone calls were real in those cases because they're like, well, how could those be real? Interesting thing. I did like a, like a sub study of just those phone calls. And so I spoke to the investigators who made the phone calls and then like got their, the downloaded their Skype records from their actual account. They let me log into their account and downloaded them. And it's got like the call time and date and then the duration of the call and then like match that to the Actual audio file. And then it's got the numbers they called. And then I would call those numbers back and like say, is this, you know, the so and so hospital? And they would say, who is this? And then I would hang up. And like, so I confirmed to my satisfaction that like the call records, they showed that they made that call to that number of that length of time, and then the audio matched it. So I mean, the calls are real. But yeah, it's, it's like for anyone who's actually looked at the transcripts, it's rather extraordinary that these things would just be said on the telephone.
- [14:34]
B
So when it comes to the identity of the organs, you mentioned that this is contentious, the identity of the source of the organs. So what is it that you've come to believe based on your extensive research?
- [14:43]
A
So the most contentious point on that is whether they came from Falun Gong or not. And then kind of the more contemporary question is, are they coming from Uyghurs or not? And on both of these. So I think you could think of the calls as direct evidence, potentially. Like, if you believe the calls. Well, you have like surgeons on the call saying, yeah, we've got, you know, the Falun Gong organs. Are they like upselling? Are they just, are they just running their mouths on, you know, a random phone call? The, the way that I have approached this. So I have a paper as part of my dissertation that specifically looks at this question of like the identity of the organs, because that's significant. If the organs are coming from death penalty prisoners, they have a situation where the state, so you can explain the emergency transplants, potentially even by death penalty prisoners, where the state has blood typed prisoners, but they just haven't actually carried out a formal judicial execution until they've been required for an organ. And the other possibility is obviously they're doing extrajudicial executions of political prisoners. And so prior to, you know, 2017, 2018, when the mass detention of Uyghurs took place, the repression of Falun Gong was the largest repression of a religious group in China. And so there was mass detention starting in 99. And so the. In terms of the organ transplantation system, one would not expect without any prior information that the growth of transplantation and the detention of a particular religious dissident group would be connected. But if you look at indicators of transplantation activity, several key indicators suddenly go up in the year 2000, so, you know, six months after the repression. And so for my work, what I've been able to gather is a large corpus of Medical publications. So I downloaded something like 100,000 PRC medical papers. And usefully, they're in like a single database, um, and they show, when you kind of do a lot of things to code them according to their content and whether they are like a, a clinic, like a clinical paper about a particular transplant, they suddenly go up in the year 2000 and then they dip a little bit in early 2006, which happens to be when the actual, the revelations of forced organ harvesting, as it's called.
- [17:40]
B
It was when I first realized it was real, that I felt the evidence, I mean, I didn't want to believe it. I remember right. This seems so outlandish, but I felt at that point the evidence was compelling enough that it was real.
- [17:55]
A
Sure. So that's like, you know, you have this temporal observation. There's two explanations, right? When you see like, you know, mass repression of this group, mass detentions, and then, you know, blood tests, you know, these, these phone calls, targeted organ examinations. There are some particularly acute cases where a surgeon has another hat of like the, the leader of an anti Falun Gong propaganda group. And that's unusual. Like why would a, a liver transplant surgeon also be specifically involved in like repressing a religious minority? And then on the other side there are, there's a well known case of a, of a security official who performed a lot of transplant, oversaw a lot of transplant operations. So the security official was directly involved in, in the repression of this group. And so it's evidence like that, blood tests, organ examinations and so on. You've got to explain the outcome that you observed, which is a lot more transplants. So you've either got this explanation, well, they came from this group, or you need, you basically have to say that it was actually death row. And so that the death row system is an order of magnitude larger than anyone has observed. And moreover that it continued to grow even as all indicators about death row showed that it was receding. And so these are, you know, the reports by human rights organizations based on their estimates and discussions with Chinese officials, some leaked documents, and then significant reforms to the death penalty system in 2007, that centralized review to the Supreme People's Court. I mean, there's a lot of law associated with the death penalty system that is a topic that has received far more scholarly attention than organ trafficking. And so it is a very implausible, at least I claim is a highly implausible set of hypotheses or like claims that you would, you know, have to advance, you would have to show that is actually Death penalty all along. And I'm not clear there's not a third, like, competing hypothesis for this outcome. So I think to the extent that it's contentious, it's driven by, I would imagine, just a simple lack of knowledge of the observations. Just, you know, the outcome, like, lots of transplants and a lot of growth in the transplant, you know, infrastructure. So there's so many different ways of measuring that growth. There's like the number of surgeons, the number of hospitals performing transplants. That is like new hospitals and hospital wings know, the advancement in different kinds of transplants because a liver can be transplanted in different ways. And so Chinese surgeons are like, have been on the cutting edge of, like, surgical improvement in actual performing transplants. And you need to do a lot of transplants for these things. So, like, everything shows there were lots more transplants being done. And so you have to explain that. So the paper I have is the dissertation is like, looking at the competing explanations and then chasing down data that supports or doesn't support either of them.
- [21:44]
B
And I mean, bottom line is the other explanation isn't very plausible. Of course I'm familiar with your work.
- [21:53]
A
Yeah, yeah. Well, so the other, the death row explanation hasn't even been seriously advanced, but it's the only alternative. But no one's, like, come out and.
- [22:02]
B
Claimed that this paper, Execution by Organ Procurement Breaching the Dead Donor rule in China. I often use that paper and thank you for co authoring it with Jakob Levy as one of the closer things to a smoking gun, because, I mean, it's written into the transplant literature that these transplant surgeons and researchers are killing people by extracting their organs. As you met, as we discussed earlier, it's shocking. I mean, it's shocking to me that they let you publish with that headline, actually, and I'm really glad they did because I think a whole lot of people suddenly understood something they didn't understand before. What kind of interest has that paper generated? You know, I guess what has come from out of that subsequently, because I found it to be incredibly compelling.
- [22:57]
A
Two things to me, strike me as interesting about that paper. So the finding itself wasn't the shocking part to Dr. Levy and I, it was that we actually saw the data. So, like, both of us were prepared to believe that this was real based on work that had already been done and then. But we were only surprised to find that we could actually count lots of them through some, you know, looking through these papers with some basic coding methods that now you can be done way easier with AI. But anyway, so that we found them at all was like the surprising part to us. And then the other was that it wasn't actually new information. It had already been shown by World Organization to investigate the persecution of Falun Gong. So it's an advocacy group that has all this kind of evidence on the repression of Falun Gong. And then in a paper, and it might have even been two papers by Li Huige and some colleagues where had been shown that there were instances of this. So I think what Dr. Levy and I added was simply a systematic methodology and then getting it into a journal. But the actual bare facts were not new. And that's interesting because it kind of suddenly something becomes real because an institution in a position of authority has declared it to be so effectively, but it was already real before we got it published. So I think that's interesting because a lot of this kind of seems to hinge on questions of authority. Who has been authorized to declare something to be a fact about this topic?
- [25:00]
B
So you use a lot of these computational methods. You mentioned that AI, some of them can be done better with AI language models today. Can you just give me a basic picture of like, what you do, what you specialize in, your kind of career trajectory?
- [25:16]
A
Yeah, the field is called computational social science, or social data science is another word for it, but it's simply using computers and it's like building data sets out of. Creating data sets out of text, wrangling text into grids, extracting variables from unstructured text, and then doing statistics on them. For example, with the medical papers, that was like many months and thousands of lines of code just to get into the website and to download all the files. That's only the beginning, because once you've got it, you now need to extract the text from the PDF files. So it's a lot of just very grunt work. Yeah, there's nothing glamorous about it. So it used to be really hard to do that before AI, so you had to actually write code yourself, but now you can just tell the computer to write your code as long as you know exactly what it is you want.
- [26:30]
B
So and so. But. So how did you get into this?
- [26:32]
A
Well, I was frustrated with the. The epistemic status of the topic. So that is, some people thought it was real and some people didn't think it was real. There seem to be taboos around figuring out what's going on and doing so properly. Also, I had a great deal of ignorance about what it actually means to do scientific research, especially on a topic like this. And so I Wanted to figure out, like, well, how do you actually produce knowledge? Like, what methods do you need to create reliable knowledge on, like, things that are hard to study. It's interesting to reflect in hindsight that it's not. It's not clear that the actually producing knowledge artifacts changes what people think. You would think it would, but it's. It is not like, like the necessary relationship between those two.
- [27:41]
B
It's not one to one, but it does help.
- [27:44]
A
I'd like to think so.
- [27:45]
B
I can tell you it does, because again, this is the reason why I often cite your paper, the execution by organ procurement paper, because it's highly compelling knowledge which was created as you described or at least resurfaced and validated.
- [28:03]
A
Yeah, sure. So there it also, there's a certain. It relies on authority to a degree. We trust that because it's the American Journal of Transplantation, the reviewers have done their job and so on.
- [28:15]
B
I think it's based on my. Basically, in my opinion, I think it's particularly valuable because as you mentioned, there's a bit of a taboo around this issue. All sorts of. In academia, in the transplant industry, all sorts of areas, as you well know. Yet it was actually validated by a very, I guess, prestigious authority on the issue. And so I felt that that actually elevated the issue considerably because I would imagine they actually experienced some pressure, some thought about to perhaps not to do it, as is often the case with publishing contentious things in my mind, the use of Falun Gong practitioners for these organs. I think that's been pretty well established through your work and the work of some others. The next claim is that at some point Uyghurs started being used the same way. And to me this makes perfect sense because when, unfortunately, this issue wasn't dealt with in any meaningful way. And these types of crimes against humanity have a way of spreading way of when they're left completely unchecked. Right? So it makes perfect sense that that would happen. We know that Ethan Gutman, who's one of the big researchers on this issue, is working on a book as we speak. Looking at this question, when it comes to Uyghurs, he's written one of the more definitive books on the issue in the past, the Slaughter. But what in your mind is the reality of that, of this having moved, or at least, you know, incorporating the Uyghurs as a.
- [29:58]
A
As a source to begin with? You have a situation where, you know, hundreds of thousands to up to a million, to over a million, who knows, a large number of people have been incarcerated. It's been described as a genocide by the U.S. state Department. And then we know from the Xinjiang police files, this is a leaked cache of documents that was leaked to my colleague Adrian Zenz at the Victims of Communism Memorial Foundation. So that shows that there's been a mass blood testing of this population. And then there's large scale DNA collection as well. And then there are accounts by survivors of strange medical examinations. So urine tests that are repeated. It's not clear what condition that's aiming to detect. So it's not just urine tests, but like ultrasounds of abdominal organs, CT scans, urine tests, blood test. So these are. And especially when they're repeated. So they don't seem to be aimed to assess the general health of the detainee. They seem targeted. And then there are, or there's at least one instance where a hospital and a work camp are literally next door to each other with a crematorium. That's in an RFA report. And that's strange. Recently the, the government announced that they were building more hospitals in Xinjiang. There is still many transplants being performed, but the official explanation that they're from voluntary donors seems at least partially implausible because the figures appear to have been manufactured so that the registry data associated with the reform program appears to have been falsified based on a simple equation. We have a paper about that that was published in 2019. So it's rational to believe that Uyghurs being harvested for their organs. And I feel like I'm not sure what else as an analyst one is permitted to say necessarily, like we don't even have such a clear like outcome that is crying for an explanation because we don't even know the number of transplants anymore. So like before 2006 and 7 and even into 2010s, there's a lot of stuff being published on Chinese hospital websites. And then when a whole lot of international attention kind of started coalescing on it, it seems a lot of that just, you know, got pulled. And then now there's a voluntary transplant system and surgeons aren't going to the media and just mouthing off about we did 2,000 liver transplants at our hospital last year and things like this. And so our ability to even observe the activity is diminished. And so, I mean, that's the state of affairs there. So I like have a book chapter about it and I use the words of vulnerability. So they're obviously vulnerable to this abuse.
- [33:49]
B
This question of vulnerability is really interesting and very important and I think actually is a piece of the evidentiary pool. Because when it comes to the Falun Gong, for example, right, you have a population that the dictator at the time has said should be eradicated. That doesn't mean to. Didn't necessarily mean to kill everybody. Re educate them, transform them. But the language, as we know language is very strong. And of course these types of things can escalate easily from something that could mean at the beginning, you know, re educate them or something like that, to something that makes it a lot easier for someone to do things of this nature. Or the unwritten rule that all felon God deaths will be considered suicides. It's okay to torture these people in extreme ways, to re educate them, or the fact that they don't reveal their names because they don't want to implicate their relatives or have. So there you have this huge nameless population in incarcerated population and people just are dying because of torture. And so would you really miss anybody because they were organ transplanted? You wouldn't even know that that's what happened. Right? Just. It's a unique kind of scenario that these people are existing into. The vulnerability, I think is an incredibly important part which often I guess is overlooked even when I talk about the issue.
- [35:14]
A
You mentioned something about language used and I just remembered. So the surgeon that I spoke about that was both a liver transplant surgeon and then he's involved in like antiphalong activities. So in the Question of Language, I found a book that he was the editor of and it was stamped Internal Circulation Napel Fatting. And he writes in like the foreword to this book that Falun Gong is a cancer on society. This struck me because he's a liver transplant surgeon. Like he removes cancer. You can see the sense in which he probably thinks if he's killing these people, it's not bad. Like if he's writing that these are evil people who are just destroying the foundations of our society and they're a cancer and so on and so on. Like it's genocidal language.
- [36:12]
B
Obviously, one of the things that struck me after first reading your paper again, execution by organ procurement, was that, you know, clearly this practice, I mean, you didn't. This was not an exhaustive search of all the transplant literature in China that you looked at and you found, I think it was 71 cases in that paper where this dead donor rule was violated, where people were being killed by the organ extraction itself. There's probably a lot more.
- [36:40]
A
Right, well, so the funnel is like this. The transplant is performed. Some number of those transplants that get performed have A paper written about them or are included in a paper. If you think how many transplants a doctor might do, what portion of them actually get written into a paper, it's probably a fraction. So like there's a, there's initial selection there that not even could we find the paper or was it in the database and did we find it with our search, but was it even written up so that. Yeah, but yeah, so that's like the first thing. And that's why we probably only got 71, you know, did we find it in our database? Did we include it properly in our, in our keyword searches and stuff? We had to chuck several dozen that didn't have a very explicit statement about intubation. So that is the insertion of the breathing tube and the ventilation of the patient. So where it said that they were ventilated, we didn't include those because it didn't say the specific word intubate Cha guan. And so we could have declared 100 and something if we use the slightly less stringent criteria. And we have like several paragraphs that explain, you know, why we think they really, you know, should have been part of it. But we just wanted to be extremely careful in like, you know, segregating the ones that were explicit about intubation. This specific act of intubation and then the probably what was identical, the turning on of the ventilator.
- [38:20]
B
There's probably a lot more. That's kind of what I. What we're getting, what we're getting at here. But, but the issue is that because there's so many of this, so much of this reality happening where people are being killed by the organ extraction itself, it's kind of become normalized for surgeons to do this. So surgeons have become murderers.
- [38:41]
A
I mean, there is just a technical challenge in the procurement of a heart from someone who is alive and like walking around like you can't kill kill them so that they're like their heart stops beating because then the heart will not resuscitate, you know, in the host. What I'm saying is there's not really another way even theoretically to do heart transplants from executed prisoners. So the way that it could be done theoretically is somehow the judicial system is able to conduct an execution that is a brain death execution. So it can't be like a firing squad, probably can't be hanging or some other method because it has to be a very targeted method of killing that is only brain death killing. And then they would need to be intubated immediately by the medical people. And that's how the medical, you know, establishment or like the profession of doctors could be kind of insulated from the actual act of killing. That is highly logistically complex. In a state like China, the medical profession does not have actual professional autonomy. Like it's an arm of the state. And I, like, that's the key. So when you say like doctors have become killers, that. Yeah, it's how you define a doctor, I suppose. Like, because the thing that goes into doctor. So we have a lot of connotations to the term doctor. Like, well, they, they kind of, they understand themselves to be a doctor. So there's like this Hippocratic oath, there are professional associations. You have kind of like all this kind of institutional scaffolding around this role. So in a state like China, some of those things are present, but they're also controlled by the Communist party. And so I think that goes some way to explaining kind of what we see. Because if kind of the medical field is an arm of the state, then it becomes less surprising perhaps because the doctors are perhaps acting in their capacity not merely as doctors, but as agents of a state entrusted with a certain responsibility to conduct this particular activity. They don't have much choice in, because they can't say, well, no, I don't.
- [41:26]
B
Want to do that, or the consequences of saying, no, I'm not going to do that are, well, they extreme?
- [41:32]
A
Yeah, like, I mean, I've heard people being concerned with their own lives. If you're, if you're a doctor at a military hospital and the supervisor says we're going to, you know, retrieve organs now, you can't just say, oh, sorry boss, like I'm not super into that.
- [41:51]
B
So how did this whole thing begin? I mean, my, my contention is that, you know, this system first and foremost provides an unlimited on demand source of organs for every party elite forever. That's the system that has some huge value above and beyond the financial value. Right. It's something that's kind of unimaginable for most people and in most settings. Your thoughts?
- [42:19]
A
To begin with, before there was like marketization or the privatization of the healthcare system and you know, the reform era, there were transplants happening, you know, in the 70s and the 80s, of course, 80s is, you know, the economy is changing and state controls are being lifted. But through. So the earliest that we can trace the origins of the CCP healthcare system, there has always been like a chair or a vice chair of the healthcare committee of the ccp. It's called the Bao Jianwei, who has been a transplant specialist. And so like the personal physician to Zhou Enlai was a transplant specialist. So what can you infer from that? Well, to begin with, a little bit more about this healthcare committee is probably helpful. So the ccp, the leadership has their own special health care system.
- [43:29]
B
And I just want to jump in. This is incredibly important to know. This is not obvious to everybody that's watching.
- [43:35]
A
No. And also it's also unusual in that. So there's a, there's a whole paper just about the CCP's healthcare system for treating the elite by Taiwan Shen. And it so one, not funny, but like unexpected consequence of this tightly controlled healthcare apparatus. So it delivers like the very best healthcare that China can offer, mostly through military hospitals. But in cases where officials have been, you know, not in line with party leadership, healthcare has actually been withheld from them. And so it's even a tool of control for the leadership. But in any case, so you have this system that delivers, you know, top notch healthcare through certain mostly military hospitals. It's always had a transplant official. And since, so since the 90s, there have been defectors and different kinds of information about organ harvesting. So this is all like pre Falun Gong stuff. And there wasn't at that period, like China wasn't wealthy like it was in the 2000s, and there was a limited pool of donors. As a, as I read it, you kind of have this confluence of events where China is getting rich, it's being integrated into global economy. Surgeons who have done training in Japan or the United States are coming home. And the healthcare system has been basically de facto privatized. And China has an economic growth model that is based on directly incentivizing officials. It's called prebendalism. It's the fancy term, but it's where a form of graft is incentivized and encouraged and allowed as a means of economic development, where officials who grow their local economies or their work units are allowed to skim off that growth. And hospitals are no exception. And then suddenly you have an influx of this detained population that can apparently be killed with impunity at a time when hospitals are being privatized. And you have this, you know, talent in transplantation. So you were asking like, how did this all begin? And like that's my reading of it. So I'm not sure, like we can't know if there was an order, hey, you know, kill these people. But I argue you don't require, like that's not a necessary condition for what we observe. You just need, it's just markets like, it's just they created a market in the organs of their political enemies. You know, they were filling a demand because the demand for organs is very big. And if you just have these people detained, you can make them effectively slave laborers or you could monetize them by converting their bodies into organs. So it's not like it's, it's. It's rational under the conditions of that system to monetize them. Like, I didn't say anything that's so hard to believe or so implausible, like, we might be shocked. We might say, well, that's really bad or whatever. But I, I just mean within the constraints of that system, with the incentives of that system, it just seems so obvious.
- [47:44]
B
And the abject lack of moral boundaries in that system would be another piece to add.
- [47:53]
A
Sure, you need a definition of morality and blah, blah, blah. But sure, sure.
- [47:57]
B
I mean, morality that us and most people that would be watching this show, the basic level of morality, like you don't kill people for monetary gain.
- [48:09]
A
Yeah, sure.
- [48:10]
B
I mean, we're talking about such macabre things. Please continue.
- [48:13]
A
No, well, because that, because what you say is really interesting because I think implicitly the objection or the aspect of it that perhaps leads to a lack of credence in these claims is that they seem really bad. And so therefore it couldn't really be that bad. But I think it's helpful to just, like, put aside how we think about whether it's good or bad and just look at the actual, the constraints and incentives of the actors in that system. Because then you would see, like, probably everyone would agree with all the things I said. Like, it's obvious, but they wouldn't. But then you kind of. Then you basically, you have to, like, everything bottoms out at some absurdity heuristic. And so you kind of. It's. Whether you think it's more absurd that the actors in that system would elevate this, These notions of morality, however we think of them in that environment. And like, that seems to me way less plausible then that they would just respond to the incentives that they're actually operating under.
- [49:33]
B
Well, and I just something you just reminded me of that I haven't thought of in years. But there was this, I think, official directive against the Falun Gong. It was something like bankrupt them financially, destroy them physically, destroy their reputations. I think there were three things like this. The destroy them physically part, again, sort of, you know, speaks to the incentive structures. And the incentive structures, as we know, in a communist society, whatever, that whatever is said at the Top, your success as a party member or a societal member is your ability to implement the strategies or tactics or whatever that are set at the top, however inhumane or macabre they may be. You use the term extractive repression. Explain that.
- [50:20]
A
When political scientists look at cases where authoritarian states repress their population or subgroups of their population, and it is thought to be a cost. You're expending, you know, resources of your security apparatus and you're maybe undermining your legitimacy and so on. I'm simply attempting to direct attention to. To a form of repression that is profitable and which the state can then use to enhance its capacities through the act of repression. So there's not a cost to the state because they simultaneously profit financially, you know, both individual surgeons and then hospitals and the medical system. But China wins recognition globally for being a leader in transplant techniques, you know, and publishing in top journals and kind of winning the. The praise, not kidding, of. Of Western surgeons for innovations in transplantation that happen in China. Again, it's about making sense of this, you know, this form of very unusual form of state activity and to try to unpack how it does make sense. So that's like where the term comes from and how I've tried to kind of puzzle. De. Puzzle the issue.
- [52:11]
B
So as you were discussing this earlier, I was one of the revelations when we were making Finding Manny, the Holocaust documentary made about my wife's father, was I just having even read a lot of literature, I hadn't realized how important Jew slave labor was to the Nazi war machine, to the German war machine. It was unbelievable how many of these slave labor camps, you know, and then. Which were later funneled into the. Into the death camps there were. Right. And how important that was. So there was this attempt at extracting whatever value was possible, never mind, you know, later, you know, collecting the gold fillings and God knows what else, right. At the death camps themselves. But that's a really interesting observation. You just reminded me of something we've talked about before, which is just the odd reality. This is something, you know, having sat in this, looking at this issue for 20 years, I had never considered how odd it is that this extractive process of, you know, monetizing human beings of your own population for a state to actually be, you know, at some level, selling the body parts of their own citizens to foreigners.
- [53:29]
A
It somehow seems perhaps more perverse that it is one state's own citizens and then the beneficiaries are citizens of foreign countries. But following the logic of the market, you could see well, foreigners are going to pay more and the kind of the demand for an organ is very high because that's a life, that's someone's life. So they're willing to pay lots of money, obviously. So again, it makes sense. If you think about it here in.
- [54:08]
B
The US where we're interviewing, there's a number of pieces of legislation now that have actually passed the House. There's one that's still in committee in the House and are now at the Senate trying to deal with this issue. Right. In various ways. You know, broadly speaking, there's, you know, sanctioning individuals that are involved would be in some of, part of that, some of it is actually creating a reporting system where the government has to kind of gather data to try to figure out what's going on with it in more detail. Another part is, you know, preventing certain medical systems from paying. In the case of insurance or Medicare or something, I'm paying. That's more at the state level at the moment, although this bill in committee does that as well. I'm curious if you have any thoughts on this legislation to try to deal with this issue somehow for people in.
- [55:05]
A
Civilized countries, it seems like a fairly good initial response. I mean, we say initial, but it's 2025 and this issue has been known about for over 20 years. So the kind of remedies, I think if we accept or believe that PRC doctors have done all these things, it is also simultaneously interesting and unusual that they simultaneously wish to be part of global health governance or they don't want to be a pariah state. And so PRC health officials have made tremendous efforts to try to make sure that they're not considered a pariah state. And so that includes extensive interactions with global medical bodies and experts and surgeons in the United States and elsewhere. And so legislation that prevents them from entering the United States has got to be awkward and embarrassing for them. At the very least, it means that the conferences can't be held here. If you think of it in terms of all the scale of remedies, it seems not even beginning to redress, you know, the, the gravity of what's alleged. But it seems better than nothing to the extent that a state wishes to craft policy in response to this, I think it's really interesting and illustrative to compare the kind of global reaction to organ transplant, the kind of the organ trafficking or transplantation abuses to what happened with psychiatric abuses by the prc. So in the mid noughts, China was again was actually an abuse against Falun Gong primarily, and then others as well where the, the state was using psychiatric care homes, but you know, psychiatric torture facilities and injecting these people with drugs. And they had a whole diagnosis of mental illness associated with specifically like qigong induced psychosis. And they had various medicalized methods of detaining people for their religious beliefs and then torturing them to elicit confessions and so on.
- [58:03]
B
But I just want to clarify this. They created a diagnosis to allow them to incarcerate Falun Gong practitioners for practicing their faith.
- [58:13]
A
Yes, so this is quite well known. And the reason in fact it's so well known is because of a man called Robin Munro who is like a chief inspiration for me. He was associated with, he was a researcher for Human Rights Watch during this period and did a lot of really groundbreaking work on abuses in orphanages and all kinds of things. And then so his work on this topic, psychiatric abuse, he with HRW at the time went to the World Psychiatric Association Conference, I think it was in Japan at the time, and this is the mid 2000s and they gave everyone like a copy of his report on these abuses. And so that created like, you know, and then they had a media campaign because it's Human Rights Watch, like it's a, it's a credible international human rights organization. And so kind of the weight of that organization, he, you know, corralled it and, or there was internal buy in or whatever, but they threw their weight behind this and they like mobilized their resources and they like browbeat the international psychiatric establishment into taking China to task for like using psychiatric doctors as part of, you know, a religious repression campaign. And the China Psychiatric association was being threatened with being kicked out of the wpa, the World Psychiatric Association. And so the upshot was China, the CPA acknowledged no wrongdoing and you know, and it was scurrilous allegations and all this sort of thing, but the abuse stopped. Like it actually stopped. So it appears that there's been a resurgence in this method of abuse. But legitimately this is a campaign where the PRC was doing this particular kind of abuse. There was a channel of pressure applied to them through, you know, like a combination of, of a respected human rights group media and then the professional associations with clear consequences for, for Chinese psychiatrists who then one imagines applied, you know, back pressure internally that like we can't be doing this, like China will lose face. It's not just going to be bad for us psychiatrists, Chinese psychiatrists, keeping in mind that they may not have even wanted as a professional body to be associated with this, but they don't have a choice. So anyway, so that was like the outcome there. So if you like, contrast that to the transplant case, I mean, everything is different. So you have no Human Rights Watch or Amnesty International who has thrown their way behind this and said, you know, even on the margin, not even said, you know, the pattern of evidence is disturbing or whatever, you know, and so there's been nothing. And then kind of influential media have not reported on it, or when they have done so, they have sought to cast out like, well, whatever's going on, it's probably not what they say.
- [61:56]
B
Or sometimes they say they'll say, well, Falun Gong practitioners claim that.
- [62:01]
A
Yeah.
- [62:01]
B
As opposed to like there's this well established body of evidence that claims that.
- [62:06]
A
Sure, yeah. And so there's all sorts of ways of using language to subtly delegitimize perspectives and so on. And so the effect, like this is my reading, the effect of all this is that there's no kind of environment under which the transplantation society or the World Health Organization or other relevant bodies who are kind of the. The global interface with the Chinese transplant establishment. So they're not incentivized to put pressure on them. There's no consequence for not caring about it or doing anything about it. And so there's no pressure on the China transplant establishment. And so there's no incentive to even change the activity. But I'm sure, like, if the state, like the US Government wanted to, like, actually put pressure on, like professional associations and so on, like the states have all kinds of tools. They're very powerful entities that can do things in the world. So if you would like, list of all the possible things that could be done, it would be as long as your arm. And the legislation is going to address some of them, of course, depending with you. If you looked at all the tools that the US Government has to change realities, I'm sure there's countless more things that it could do, right?
- [63:35]
B
Well, no, it's in it, but it's what's really fascinating from what you just told me, which I wasn't familiar with, the details of how this all came to pass, is there's a playbook of something that worked. Yeah. And you could replay that. And this is something, frankly, that almost anyone could participate in if they're part of their, you know, of a human rights organization or could choose to become part of one or could, you know.
- [64:02]
A
The key is it was elite networks that led to that effect. So it kind of like many things depend on people who have more power doing things.
- [64:17]
B
And some of those people are certainly watching right now. Well, this has been an incredible, illuminating conversation for me, and it's great kind of to finally have you here and on the show. You know, I often talk about your work as part of my work. And a final thought as we finish.
- [64:38]
A
Perhaps, I think that anyone who is organ harvesting curious is wondering if this is actually a thing. I would say just actually read the papers, just look at them and use your own brain to assess the evidence.
- [65:02]
B
Well, Matthew Robertson, it's such a pleasure to have had you on.
- [65:05]
A
My pleasure.
- [65:06]
B
Thank you all for joining Matthew Robertson and me on this episode of American Thought Leaders. I'm your host, Janje Kellick.