Facebook nudges you to donate your organs

Founder Zuckerberg adds "organ donor" to "life events" list in UK and US.

Mark Zuckerberg wants you to donate your organs.

Conversations over the dinner table with his medical student girlfriend convinced the Facebook founder that he could be doing more to help increase the supply of donated organs. Speaking to ABC News, Zuckerberg said:

Facebook is really about communicating and telling stories… We think that people can really help spread awareness of organ donation and that they want to participate in this to their friends. And that can be a big part of helping solve the crisis that’s out there.

The actual change on Facebook's part is small. Starting today, users in the UK and US can go to their timeline, click on "Life Event," select "Health and Wellness," and add the new option "choose Organ Donor":

Whether or not the initiative actually helps increase the number of organ donors remains to be seen. The ability to add it to one's timeline is fairly well hidden, and the act of signing up to be an organ donor isn't quite the sort of life event that Zuckerberg seems to hope. I joined the register the first time I got a Boots clubcard – not quite something I feel strongly about marking into the story of my life.

While it may make more sense to add as a binary category rather than a "life event" – so that it's alongside things like relationship status, religion and political views rather than births, marriages and deaths – the actual efficacy will depend on the rather capricious whim of the social network. If everyone who is an organ donor adds that fact to their profile, then those who aren't may start being aware of it in a way that may cause them to act.

There are a lot of "mays" and "ifs" in that, of course. It's equally possible that no one will update their organ donor status, and the initiative will go unseen. But if Zuckerberg succeeds, it will be one of the largest applications of "nudge theory" to date. The idea is that changes in the framing of a question – from highlighting the way peers answer to changing the default response – can massively change the proportionate outcomes. The most effective example of this is given by Sara Kliff at the Washington Post:

Organ donation rates are 25 to 30 percent higher in presumed consent countries, according to a 2005 paper in the Journal of Health Economics. When Belgium instituted a presumed consent law in 1985, the number of organ donors nearly doubled within two years.

Facebook is unlikely to get that sort of takeup. But if they manage even a tenth of the effect of presumed consent, that would result in around 400 extra donors a year in the UK and US, and around three-and-a-half thousand lives saved. Few can argue with that.

Zuck fights against the powers of darkness. Photograph: Getty Images

Alex Hern is a technology reporter for the Guardian. He was formerly staff writer at the New Statesman. You should follow Alex on Twitter.

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A swimming pool and a bleeding toe put my medical competency in doubt

Doctors are used to contending with Google. Sometimes the search engine wins. 

The brutal heatwave affecting southern Europe this summer has become known among locals as “Lucifer”. Having just returned from Italy, I fully understand the nickname. An early excursion caused the beginnings of sunstroke, so we abandoned plans to explore the cultural heritage of the Amalfi region and strayed no further than five metres from the hotel pool for the rest of the week.

The children were delighted, particularly my 12-year-old stepdaughter, Gracie, who proceeded to spend hours at a time playing in the water. Towelling herself after one long session, she noticed something odd.

“What’s happened there?” she asked, holding her foot aloft in front of my face.

I inspected the proffered appendage: on the underside of her big toe was an oblong area of glistening red flesh that looked like a chunk of raw steak.

“Did you injure it?”

She shook her head. “It doesn’t hurt at all.”

I shrugged and said she must have grazed it. She wasn’t convinced, pointing out that she would remember if she had done that. She has great faith in plasters, though, and once it was dressed she forgot all about it. I dismissed it, too, assuming it was one of those things.

By the end of the next day, the pulp on the underside of all of her toes looked the same. As the doctor in the family, I felt under some pressure to come up with an explanation. I made up something about burns from the hot paving slabs around the pool. Gracie didn’t say as much, but her look suggested a dawning scepticism over my claims to hold a medical degree.

The next day, Gracie and her new-found holiday playmate, Eve, abruptly terminated a marathon piggy-in-the-middle session in the pool with Eve’s dad. “Our feet are bleeding,” they announced, somewhat incredulously. Sure enough, bright-red blood was flowing, apparently painlessly, from the bottoms of their big toes.

Doctors are used to contending with Google. Often, what patients discover on the internet causes them undue alarm, and our role is to provide context and reassurance. But not infrequently, people come across information that outstrips our knowledge. On my return from our room with fresh supplies of plasters, my wife looked up from her sun lounger with an air of quiet amusement.

“It’s called ‘pool toe’,” she said, handing me her iPhone. The page she had tracked down described the girls’ situation exactly: friction burns, most commonly seen in children, caused by repetitive hopping about on the abrasive floors of swimming pools. Doctors practising in hot countries must see it all the time. I doubt it presents often to British GPs.

I remained puzzled about the lack of pain. The injuries looked bad, but neither Gracie nor Eve was particularly bothered. Here the internet drew a blank, but I suspect it has to do with the “pruning” of our skin that we’re all familiar with after a soak in the bath. This only occurs over the pulps of our fingers and toes. It was once thought to be caused by water diffusing into skin cells, making them swell, but the truth is far more fascinating.

The wrinkling is an active process, triggered by immersion, in which the blood supply to the pulp regions is switched off, causing the skin there to shrink and pucker. This creates the biological equivalent of tyre treads on our fingers and toes and markedly improves our grip – of great evolutionary advantage when grasping slippery fish in a river, or if trying to maintain balance on slick wet rocks.

The flip side of this is much greater friction, leading to abrasion of the skin through repeated micro-trauma. And the lack of blood flow causes nerves to shut down, depriving us of the pain that would otherwise alert us to the ongoing tissue damage. An adaptation that helped our ancestors hunt in rivers proves considerably less use on a modern summer holiday.

I may not have seen much of the local heritage, but the trip to Italy taught me something new all the same. 

This article first appeared in the 17 August 2017 issue of the New Statesman, Trump goes nuclear