Posts tagged with: medicine

Last week the Federal Circuit Court handed down what seemed to many a funny decision: that human genes are patentable. Myriad Genetics owns patents for two tumor suppressor genes, BRCA1 and BRCA2 (mutations of these genes are correlated with increased incidence of breast cancer, making them of great interest to doctors and scientists). Myriad was sued by doctors and researchers who claim that genes fall into the category of “products of nature,” which makes them unpatentable, but the court disagreed.

Myriad’s patents allow it to charge licensing fees to doctors who wish to screen their patients for BRCA1/2 mutations, and also to researchers developing drugs that would target BRCA1/2 abnormalities in breast cancers. Myriad claims that its patents allow it to recover the costs of identifying the two genes, and so are just like the patents for Velcro, ShamWow, or the Segway. Aside from the legal dispute—i.e., the majority’s facially risible argument that “the molecules as claimed do not exist in nature,” since bits of the BRCA1 gene aren’t floating around in ponds—there are two problems with the patenting of genes: a moral one and a practical one.

In his Acton monograph The Social Mortgage of Intellectual Property, David H. Carey addresses intellectual property rights vis-à-vis the distribution of medicine. He focuses on the AIDS epidemic and infectious diseases in the Third World, and presents the Vatican’s 2001 argument that the principle of solidarity supersedes patent rights where the lives of the poor are at stake, even though the long-term consequences of a suspension of intellectual property might be severe.

Admittedly, personalized cancer treatment in the United States alters the moral calculation, but the American public has made its consideration, and by the establishment of the National Cancer Institute (part of the National Institutes of Health), has decided to fund early stage cancer research publicly. Certainly in order recoup the billions of dollars of testing required to bring a cancer drug to market, companies need the assurance of patent protection, but the sequencing of a gene comes years before any drug begins testing (Myriad filed for its patents in 1994).

As Francis S. Collins, head of the NIH, explained in a recent book,

The information contained in our shared [genome] is so fundamental, and requires so much further research to understand its utility, that patenting it at the earliest stage is like putting up a whole lot of unnecessary toll booths on the road to discovery.

Whether the Supreme Court reverses the Federal Circuit’s decision, or Congress passes a law making clear the proper extent of patent protections, this intellectual property mess must be untangled.

I’m not sure I have ever really encountered the term intergenerational justice before this discussion over “A Call for Intergenerational Justice,” at least in any substantive way. This unfamiliarity is what lay behind my initial caveat regarding the term, my concern that it not be understood as “code for something else.”

The Call itself provides a decent definition of the concept, or at least of its implications: “…that one generation must not benefit or suffer unfairly at the cost of another.”

One of the commenters here at the PowerBlog is Peter Vander Meulen, who runs the Office of Social Justice at the Christian Reformed Church (the denomination to which I belong). Vander Meulen rightly reiterates that much of the disagreement has to do with our differing views of the primary responsibilities of government.

Much of my concern with the Call is that is does not display enough in terms of substantive commitment to principles. I think our debates about the budget crisis need to lead us back to consider from first principles what the role of government in society ought to be relative to other social institutions. (I hope to provide more on that positively later this week.)

It is on this point that my concern about the invocation of intergenerational justice in this context, and social justice more broadly, is not being construed in a vigorous enough manner.

To put it bluntly: How can a call for intergenerational justice in particular, or social justice more broadly, have any plausibility without addressing the fundamental social problem of abortion? If intergenerational justice is about the duties and responsibilities from one generation to another, it seems obvious that the starting point of the discussion, from a particularly evangelical and even more broadly Christian perspective, should be on the question of whether that next generation has a right to come into existence in the first place.

It is an unfortunate reality that social justice and abortion are oftentimes not viewed as related in this way. Acton Institute research fellow Anthony Bradley wrote last week at WORLD’s site about how abortion is often not considered a priority justice issue. In the context of the abortion rate in New York City, he writes,

I’ve been browsing the mercy and justice websites of several of New York’s well-known churches and Christian non-profit groups for discussion of New York’s abortion crisis. Outside of the crisis pregnancy centers themselves, I have not found much of anything. What one will find are very good discussions on subjects like fighting homelessness, improving inner-city education, opening women’s shelters, and dealing with sex trafficking and juvenile delinquency. I raise this issue because I am concerned that perhaps the missional pendulum has swung too far in one direction.

Closer to the context of this discussion, Mr. Vander Meulen’s agency, the Office of Social Justice (OSJ), was instructed by the denominational synod last year to “boldly advocate for the church’s position against abortion.” This instruction was deemed necessary because the OSJ did “not currently offer many resources to advocate for the unborn,” despite the fact that there is an official denominational position on the question of abortion (while there is not one on so many of the issues that the OSJ does “boldly advocate” for). You can judge for yourself whether that situation has changed substantively in the intervening time (e.g. “Advocacy…Coming Soon!”).

One of the signers of the Call, Jim Wallis, perhaps illustrates this illegitimate dichotomy between social justice and abortion in his judgments about the moral status of the abortion question. In a 2008 interview with Christianity Today. When pressed on this point, Wallis spoke candidly:

“I don’t think that abortion is the moral equivalent issue to slavery that Wilberforce dealt with. I think that poverty is the new slavery. Poverty and global inequality are the fundamental moral issues of our time. That’s my judgment.”

By contrast I do think the “Guideline on Human Life” offered by CPJ is rather more helpful and substantive than the current efforts of the OSJ to “boldly advocate” against abortion.

But shouldn’t consideration of abortion be a critical consideration in any discussion of “intergenerational justice”? The Call itself invokes the context of “generations yet unborn” and the relationship between “grandparents” and “grandchildren.”

If the connection of abortion to the budget debate remains unclear to some in the context of intergenerational justice, we might raise the following considerations:

Does the Call adequately address government provision for funding of abortions, whether through entitlement coverage or through funding for organizations that provide abortion services, such as Planned Parenthood? There are clauses advocating that “Effective programs that prevent hunger and suffering and empower poorer members of society must continue and be adequately funded,” and that “We must control healthcare expenses.”

Is funding for Planned Parenthood support for “an effective program” that prevents suffering or something that should be cut?

And there are also clear demographic and population implications for questions of future funding of entitlements, including Social Security. As I noted above, I hope to make the link more clear later this week when I talk about the need to get back to basics in the budget crisis.

With health care moving back to center stage in Washington, we’re publishing Dr. Donald Condit’s Acton monograph A Prescription for Health Care Reform as a free eBook readable in a variety of formats. This excellent work continues to be available for $6 (paperback) in the Acton Bookshoppe.

For your free eBook, visit Acton’s Smashwords page. The Condit book will soon be available in the Kindle store (no charge for that, either) and in other eBook retail sites. We’ll keep you updated when they become available.

Via Smashwords, you can download digital versions of the 81-page health care monograph for eBook readers, smart phones and computer screens.

The monograph was released before the passage of the Patient Protection Act in March. Dr. Condit has recently authored an update in the November 2010 issue of the Linacre Quarterly, published by the Catholic Medical Association. The medical association has graciously offered readers of the Acton PowerBlog an open link to Dr. Condit’s new article, “Health-Care Counter-Reform.”

The Jan. 5 Acton commentary was based on the Linacre article. Read “Obamacare and the Threat to Human Dignity” by Dr. Donald Condit.

From the Jan. 5 Acton News & Commentary. This is an edited excerpt of “Health-Care Counter-Reform,” a longer piece Dr. Condit wrote for the November 2010 issue of the Linacre Quarterly, published by the Catholic Medical Association. For more on this important issue, see the Acton special report on Christians and Health Care. Dr. Condit is also the author of the 2009 Acton monograph, A Prescription for Health Care Reform, available in the Book Shoppe.

Obamacare and the Threat to Human Dignity

By Dr. Donald P. Condit

Since President Obama signed the Patient Protection Act into law in March 2010, the acrimonious debate on this far-reaching legislation has persisted. For many, the concerns over the Obama administration’s health care reform effort are based on both moral and fiscal grounds. Now, with House Republicans scheduling a vote to repeal “Obamacare” in the days ahead, the debate is once again ratcheting up.

Perceived threats to the sanctity of life have been at the heart of moral objections to the new law. Despite a March 2010 executive order elaborating the Patient Protection Act’s “Consistency with Longstanding Restrictions on the Use of Federal Funds for Abortion,” many pro-life advocates fear a judicial order could reverse long-standing Hyde amendment restrictions on the use of federal tax dollars for abortion. Impending Medicare insolvency and the Patient Protection Act’s establishment of an “independent payment advisory board” to address treatment effectiveness and cost suggest bureaucratic restrictions on the horizon for medical care of the elderly and disabled.

The objections made on fiscal grounds are serious. Prior to the 2008 presidential election, Barack Obama voiced concern for 47 million Americans without health insurance. More recently, supporters of this legislation focused on 32 million Americans, with 15 million immigrants and others left out of the equation, yet still requiring care in United States emergency rooms. The Patient Protection Act increases eligibility for Medicaid recipients, yet state budgets are severely strained with their current underfunded medical obligations. Moreover, doctors struggle to provide health-care access to Medicaid patients when reimbursed below the overhead costs of delivering care.

Who Should Pay?

The perception among consumers of third-party responsibility for health, including payment for health-care resource consumption, is the major factor for unsustainable escalation of medical spending in the United States. Yet the Patient Protection Act augments third-party authority and threatens doctor-patient relationship autonomy, by increasing responsibility of government and employers for health care. Patients and physicians will face increasing involvement of third parties in decision making in exam rooms and at the bedside. (more…)

Acton On The AirDr. Donald Condit joined host Drew Mariani on the Relevant Radio Network to discuss the positives aspects of end-of-life planning as well as the troubling issues surrounding end-of-life care under government health care systems. Dr. Condit is an orthopedic surgeon and the author of Acton’s monograph on health care reform, entitled A Prescription for Health Care Reform and available in the Acton Bookshoppe; he has also authored a number of commentaries on health care for Acton and other organizations; his most recent commentary can be read right here. And don’t forget to check out Acton.org’s special section on Christians and Health Care for a wealth of related information.

To listen to Dr. Condit’s 20 minute interview with Drew Mariani, use the audio player below.

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Blog author: kschmiesing
Wednesday, September 22, 2010
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Among the warnings sounded as the Democratic health care reform bill was being debated was that the federal insurance mandate included in the bill—even though not national health care per se—would essentially give the federal government control of the insurance industry. The reason: If everyone is forced to buy insurance, then the government must deem what sort of insurance qualifies as adequate to meet the mandate. This piece of Obamacare promises to turn every medical procedure into a major political fight, with special interest lobbying rather than objective medical expertise being more likely to determine what kind of health care gets covered and what kind doesn’t.

The problem goes beyond ugly politics, however, and into the realm of moral repugnance. The contention has already started, as the Catholic bishops have formally protested the pending inclusion of contraception and sterilization among items that must be covered in every American insurance plan.

Whether one agrees with Catholic morality is beside the point. The point is that this is no way to deal with a major economic sector in a free, pluralist society. Some medical doctors think chiropractors are quacks; some chiropractors think medical doctors are quacks. Some people think marijuana is an excellent pain killer; others think it is an immoral drug. The goods and services that the 300 million people in this country consider to be effective—or objectionable—instances of health care vary, sometimes dramatically, according to geography, culture, religion, and ethnicity. Now a single institution, the national government in the form of the Department of Health and Human Services, is charged with arbitrating which goods and services make the cut and which don’t. Those who lack the political clout to get their preferences included will pay coming and going: their insurance premiums will cover things that they don’t want and they’ll have to pay out of pocket for things that they do.

The variety offered by a medical market is a beautiful thing. Monolithic medicine mandated by a law that most Americans opposed is not.

Blog author: jballor
Tuesday, August 18, 2009
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A great deal has been made in recent weeks about Ronald Reagan‘s critique of nationalized or socialized health care from 1961:


We can go back a bit further, though, and take a look at an intriguing piece from 1848, a dialogue on socialism and the French Revolution and the relationship of socialism to democracy, which includes Alexis de Tocqueville‘s critique of socialism in general.

One interesting note is that Tocqueville identifies one of the traits common to all forms of socialism as “an incessant, vigorous and extreme appeal to the material passions of man,” including the exhortation, “Let us rehabilitate the body.” Reagan’s point of departure in his broadcast is the observation that “one of the traditional methods of imposing statism or socialism on a people has been by way of medicine. It’s very easy to disguise a medical program as a humanitarian project.”

And here’s Tocqueville on socialism in America:

America today is the one country in the world where democracy is totally sovereign. It is, besides, a country where socialist ideas, which you presume to be in accord with democracy, have held least sway, the country where those who support the socialist cause are certainly in the worst position to advance them[.] I personally would not find it inconvenient if they were to go there and propagate their philosophy, but in their own interests, I would advise them not to.

It may well be that ideologically democracy (as Tocqueville conceived it) and socialism are opposed, as Tocqueville claims. But historically they may well be linked. Lord Acton connected “absolute democracy” (something like majoritarian rule) to socialism: “Liberty has not only enemies which it conquers, but perfidious friends, who rob the fruits of its victories: Absolute democracy, socialism.” And once the majority discovers that it can use the power of the State to plunder the wealth of a minority, the road is well-paved toward socialism.

From the UK:

I never for a moment thought that a life could be decided by something as arbitrary as one’s address.

The often-maligned US health care system is by no means a free market for health care services; rather, it is more of a hybrid public/private system. It’s imperfect and in need of reform, to be sure. But heaven help us if that reform takes the form of a governmental takeover of the entire system. How such a “reform” would improve our flawed system is beyond me.

Blog author: mvandermaas
Wednesday, April 30, 2008
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Continuing with my posts highlighting just how wonderful things will be here in the United States when the government finally does its job and takes over the healthcare sector of the economy, I’d like to bring your attention once again to the fabulous success story that is the Canadian health care system:

Last year, the Canadian government issued a series of reports to address the outcry over long wait times for critical tests, procedures and surgeries. Over a two year period:
• Wait times for knee replacements dropped from 440 to 307 days.
• Wait times for hip replacements dropped from 351 to 257 days.
• Wait times for cataract surgeries dropped from 311 to 183 days.
• Wait times for MRIs dropped from 120 to 105 days.
• Wait times for CT scans dropped from 81 to 62 days.
• Wait times for bypass surgeries dropped from 49 to 48 days.

Sure, you might have to wait a couple of months for that lifesaving bypass surgery. But remember: it’s free!

This evening, I attended a showing of Michael Moore’s movie Sicko

I wasn’t expecting much, so maybe it was easy to exceed my expectations. But I was pleasantly surprised that the movie wasn’t far more painful for me to watch. Although certainly not without its flaws, it has something to add. And the movie was well-made, humorous in places, poignant in others– effective and provocative.

Moore is quite critical of insurance companies and HMO’s– and quite complimentary of the health care systems of France, Cuba, Canada, and England. With that combination, you would expect him to be optimistic about the United States moving toward single-payer health care. But his cynicism toward our government– in particular, the often-unsavory relationship between politicians and interest groups– leads him to criticize our system (correctly in many cases) without embracing government as a practical means to his desired end.

Some examples? Early-on, he mentions that Medicare fails to cover a lot of things (although he fails to pile on by talking about the program’s extraordinary expense). And he points to the government’s selective provision of health care to the heroes of 9/11. He also notes that the government provides awesome health care for the detainees at Guantanamo. (He could have bolstered this with the observation that our troops receive health care that is largely illegal in the states– since interest groups have restricted competition from competent providers like physicians’ assistants and nurse practitioners.) Implicitly, he notes the absurdity of restricting trade in pharmaceuticals, health care services, and health insurance. In a word, he isn’t happy with the status quo, but he’s not at all optimistic that our government can or will fix the problem.

The problem with health care– from the point of an economist– is that government is too heavily involved in health care: in addition to the above examples, we could also list Medicare, Medicaid, and most notably, government’s subsidy of health care insurance (as a non-taxed form of compensation).

Because of the subsidy, ironically, those who can afford health care insurance have too much of it. First, by definition, something that is subsidized will be purchased too much (at least in terms of efficiency). Second, imagine how insurance typically operates: it covers rare, catastrophic events. In contrast, health care “insurance” covers everything from allergy shots to cancer. By way of analogy, car insurance of this type would cover everything from door dings and oil changes to severe car accidents. And what would happen to the cost of oil changes, the paperwork associated with oil changes, etc.? We’d have exactly the same sort of mess we have in health care.

With government’s current level of involvement– very far from a market-based system– one can make an argument that a single-payer plan would be an improvement over the status quo. But of course, one can also argue that a single-payer plan would be even worse. A quick look at our education system and the post office indicate that a government-run monopoly is unlikely to deliver decent quality with any kind of efficiency or without special interest politics. This seems to be Moore’s dilemma in the proverbial nutshell.

Sure, there were examples of poor analysis in the movie. For example:
-There was a strange reference to “full employment” in England (when all of Europe struggles with significantly more unemployment than us– due to various employer mandates Moore seems to appreciate);
-He repeats the common reference to U.S. infant mortality rates (vastly oversold since we treat premies different for the purposes of that statistic);
-He repeats the tired canard that schools just need more money (while they already spend more than $10K per student; how much more money do you want to inject into a government-run entity with tremendous monopoly power?); and
-His analysis of other countries seems to miss the important factor that their populations are smaller and more homogeneous than ours.

And I suppose that other viewers– perhaps most who would see Moore’s film– could see a call for bringing socialized medicine to the U.S. in Moore’s work. But a more nuanced reading of the film points to an idealistic but laudable desire that our health care system would be something better– without holding out much hope that our politicians will be able to deliver us closer to that outcome.

— Also see Dr. Don Condit’s Acton Commentary: What’s Wacko about Sicko? – Ed.