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Home Opinion The Gift Relationship

The Gift Relationship

Iain McLean - 28 June 2010

The implications of Titmuss’ study on human blood and social policy should not be forgotten as we reconsider the core principles of our economy

His socialism was as English as his patriotism—ethical and non-Marxist, insisting that capitalism was not only economically but socially wasteful, in failing to harness individual altruism to the common good (A.H. Halsey, 2004).

For my money, The Gift Relationship is the only socialist classic of the last fifty years. Richard Titmuss (1907-73), the founder of the LSE school of social administration scholars (“Titmice”), never went to university. His only further education was a 6-month course in bookkeeping, and he worked for 18 years in an insurance office. He refused a peerage from Harold Wilson.  His last book succeeded in showing that in one arena capitalism is socially wasteful, where thousands of academic tomes before and since have failed to.

The subtitle of The Gift Relationship is From human blood to social policy. Titmuss’ central finding was that both the quality and quantity of blood for transfusion in the UK, donated through what is now the National Blood Service, were higher than in the US, where most blood at the time was supplied by the market. He showed that both the classic problems of insurance applied to blood supply: moral hazard and adverse selection. He did not use either term, but his evidence was clear-cut. In a market for blood, those with the unhealthiest blood – especially drug and alcohol abusers – had the strongest motivation both to supply it and to lie about their medical conditions. Hence, US supplied blood was more likely to give hepatitis to the recipient than was UK donated blood.  Titmuss wrote before AIDS-contaminated blood laid waste to a generation of haemophiliacs in the 1980s, but that disaster showed how right he was.

He conducted a survey of British blood donors. Some of their answers make up the most moving part of the book: My husband aged 41, collapsed and died, without whom life is very lonely – so I thought my blood may help to save some-one the heart ache I’ve had.  Or 1941. War. Blood needed. I had some. Why not? Or I thought it just a small way to help people – as a blind person other opportunities are limited.

There is, I admit, a lot wrong with The Gift Relationship. The section on the social anthropology of giving adds nothing, and the section on apartheid South Africa is a curiosity. By modern standards the survey was slapdash and it commits the cardinal sin of “selection on the dependent variable” – i.e., of failing to survey non-donors. Titmuss wrongly says that his findings condemn the whole discipline of economics. But they go deeper than he realised himself. They led some of the best social scientists in the world (including Kenneth Arrow and Peter Singer) to clarify his findings and their implications. In essence, Arrow said: Adding a market mechanism to a donor mechanism restricts nobody’s freedom and increases supply; so what can be wrong with that? Singer retorted: The market does restrict freedom because it crowds out altruism. Fewer people would give blood for a small money reward than are prepared to give it for nothing.

Titmuss’s findings have also protected the principle of non-market blood supply in the UK throughout all changes of government since he wrote; and induced US Administrations to encourage donation and discourage market supply of blood. The Gift Relationship is as relevant today as the day it was written.

Iain McLean is Professor of Politics, Oxford University and a fellow of Nuffield College. His publications include ‘Good blood, bad blood, and the market: The Gift Relationship revisited’, Journal of Public Policy 6 1987 pp 431-45 (with J. Poulton), and, ‘Regulating Gifts of Generosity: the Aberfan Disaster Fund and the Charity Commission’, Legal Studies 19, 1999, pp. 380--96 (with M. Johnes)

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The Policy Network Observatory promotes critical debate and reflection on progressive politics. It is centre-left orientated but determinedly challenges social democracy. It is pro-European but restlessly questions EU institutions and practices.

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