Tag: Distributive Justice

Blog Posts (7)

September 10, 2015

Will America Ever Come To Terms With Its Past?

<p style="font-size: 11.2px; line-height: 19.04px;"><span style="font-size: 11.2px; line-height: 19.04px;">In my <a href="/BioethicsBlog/post.cfm/some-reflections-on-summer-vacation-reading">last blog</a> I wrote, what was in effect, a review of three books from my summer reading I did while on vacation. The first book covered the life of George Washington from the time of his resignation as General in the Continental Army, through his leadership in the Constitutional Convention in 1788, until his inauguration ceremony on 1789. The second book was a narrative history of the Great Migration of African Americans from the Jim Crow south to Northern and Western cities, and the hardships they endured throughout. And finally the third book was a contemporary description of what it is like to live in a black body today in the United States. I have been continuing my thoughts on the fate of blacks in America.</span></p> <p style="font-size: 11.2px; line-height: 19.04px;"><span style="font-size: 11.2px; line-height: 19.04px;">From the era of George Washington, we see the American political and social power structure becoming embedded into a political system filled, from the first moment with enormous hope but with equal, deeply troubling contradictions. There was eloquent language of the “many” no longer having to remain subservient to the “few” that seemed to reflect through reason the rights of human kind. Yet it was equally clear that Washington’s America was created to protect the financial interests of privileged white males as many human beings were excluded from participation in the new, fledgling nation, including women, native Americans who would be driven from the lands and basically exterminated, and African Americans, a few of whom were free but most enslaved as the property of white slave owners. </span></p> <p><span style="color: #34405b; font-family: Arial, Helvetica, sans-serif; font-size: 12px; line-height: 19.04px;"><strong>The Alden March Bioethics Institute offers a Master of Science in Bioethics, a</strong> </span><strong style="color: #34405b; font-family: Arial, Helvetica, sans-serif; font-size: 12px; line-height: 19.04px;">Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our <a style="color: #000099; text-decoration: underline;" href="http://www.amc.edu/Academic/bioethics/index.cfm">website</a>.</strong></p>
September 16, 2014

Is It Possible To Do Bioethics In Contemporary America?

<p style="line-height: 19.0400009155273px;"><span style="line-height: 19.0400009155273px;">Ok, I realize I am being somewhat provocative. But there is a real and very serious issue, which I am groping to address in a more precise manner.</span></p> <p class="MsoNormal" style="line-height: 19.0400009155273px;"><span style="line-height: 19.0400009155273px;">In my last blog I described the contemporary moral setting from a philosophical perspective as one in which no single substantive normative moral perspective can resolve moral questions, such as the boundaries of human life and the scope of individual rights, with final moral authority. This is just to say, more simply and obviously when we reflect upon it, that in democratic, secular America, ethics, both philosophically and practically, becomes inextricably linked to public discourse in politics and public policy.</span></p> <p class="MsoNormal" style="line-height: 19.0400009155273px;"><span style="line-height: 19.0400009155273px;">When bioethicists ask questions and make arguments about abortion, physician assisted suicide, stem cell research and cloning, and many other similar issues that pertain to questions about the value of human life in relation to both individual rights and societal goals, we have no privileged moral authority from which to draw. As bioethicists we engage in procedural, persuasive discourse, based on conventional moral principles that most often conflict, which is why there is moral dilemma or problem requiring analysis and prioritization. Our purpose in defending a particular moral position is to win assent from others. In short, for a bioethicist to promote a moral position, it is implicitly an attempt to build a consensus among readers and listeners that will hopefully impact public opinion about a particular moral problem or question. Moreover, to the extent these questions have public policy ramifications, and practically all do, it means that moral discourse is also oriented to effect change and function as a medium in which bioethicists often speak as advocates about how moral options should be framed as public policy positions in a democratic society.</span><span style="line-height: 19.0400009155273px;"> </span></p> <p class="MsoNormal" style="line-height: 19.0400009155273px;"><strong style="color: #34405b; font-family: Arial, Helvetica, sans-serif; font-size: 12px; line-height: 20px;">The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our <a style="text-decoration: underline; color: #000099;" href="/Academic/bioethics/index.cfm">website</a>.</strong><span style="line-height: 19.0400009155273px; color: #34405b; font-family: Arial, Helvetica, sans-serif; font-size: 12px;"> </span></p>
September 9, 2014

Drug Innovation and Government-Operated Health Systems

<p style="line-height: 19.0400009155273px;"><span style="line-height: 19.0400009155273px;">On August 30, 2014, cardiovascular drug researchers managing the PARADIGM-HF Study and its Committees announced that they were terminating their Phase III trial of LCZ696 because of observed “<a href="http://www.dailymail.co.uk/health/article-2738993/Remarkable-new-heart-drug-cut-deaths-fifth-available-early-year.html">overwhelming benefit</a>.” As reported in The Daily Mail: “Thousands of lives could be saved by a new drug for heart failure that researchers claim outperforms the current best treatments. … Research on more than 8,000 patients found that it saved 20 per cent more lives than the current ‘gold standard’ treatment – the ACE inhibitor enalapril.” The <a href="http://www.reuters.com/article/2014/08/30/us-health-heart-novartis-idUSKBN0GU0CQ20140830">findings were announced</a> at the annual meeting of the European Society of Cardiology and published the same day in the <a href="http://www.nejm.org/doi/full/10.1056/NEJMoa1409077">The New England Journal of Medicine</a>. In a news release, the Switzerland-based Novartis International AG – the drug manufacturer sponsor – said that it would submit an FDA application to market the drug in the US by the end of 2014. Novartis anticipates <a href="http://www.novartis.com/newsroom/media-releases/en/2014/1852531.shtml">submitting a similar application</a> to the European Union by early 2015.</span></p> <p style="line-height: 19.0400009155273px;">Analysts say “that [the new drug] might <a href="http://www.nytimes.com/2014/08/31/business/new-novartis-drug-shows-striking-efficacy-in-treating-heart-failure.html">cost $7 a day in the United States</a>, or about $2,500 a year. Existing [standard] drugs are generic, costing as little as [$48 a year] … .”</p> <p style="line-height: 19.0400009155273px;"><strong style="color: #34405b; font-family: Arial, Helvetica, sans-serif; font-size: 12px; line-height: 20px;">The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our <a style="text-decoration: underline; color: #000099;" href="http://www.amc.edu/Academic/bioethics/index.cfm">website</a>.</strong></p>
August 3, 2014

A Cure So Expensive No One Can Afford It

<p>In December 2013, the FDA approved <a href="http://www.sovaldi.com">Sovaldi</a>® (sofosbuvir, Gilead Sciences, Inc.) for treatment of hepatitis C. A truly wonderful <a href="http://www.hcvguidelines.org/full-report/introduction">medical breakthrough</a>, the oral drug effectively <a href="https://www.ncbi.nlm.nih.gov/pubmed/23281974">cures 90% of patients</a> who take it correctly. The online physician resource Web site <a href="http://www.medscape.com/viewarticle/817371">Medscape</a> has referred to this drug as a “game changer.” Clearly it will change the health care delivery game in any number of ways.</p> <p>But the miracle comes with a catch: the cost is prohibitive. The full treatment course is <a href="http://www.newsweek.com/insurers-worry-84000-hepatitis-c-drug-sovaldi-could-break-bank-252539">so expensive</a> that very few can afford it even with good health insurance. Each pill costs about $1000; patients will need to take the medicine once a day for about 12 weeks for a full course. The total cost will be about <a href="http://www.nytimes.com/2014/03/16/opinion/sunday/how-much-should-hepatitis-c-treatment-cost.html">$90-120,000 per patient</a>. Many are asking how is it possible to justify the cost? <a href="http://jama.jamanetwork.com/article.aspx?articleid=1890401">Is this fair?</a></p> <p>Of course, the principal difficulty at first glace is that the costs will strain the system to a degree never before seen with the introduction of a new drug. The strain may break the bank. Recently Reuters has reported that one Florida health insurer – WellCare Health Plans – has sustained <a href="http://www.reuters.com/article/2014/07/25/wellcare-health-stocks-idUSL4N0Q047L20140725">significant corporate losses</a> attributable to the fact that Florida requires insurers to prove sofosbuvir to Medicaid patients. It has been reported that 47 state Medicaid programs are covering the drug, and about half have some form of preauthorization. Illinois Medicaid has recently changed its preauthorization criteria to provide the drug only to those patients with advanced liver disease, and to those who can tolerate interferon as an adjunctive treatment, and to <a href="http://www.chicagobusiness.com/article/20140729/NEWS03/140729819/ill…estricts-who-can-get-game-changing-hepatitis-drug">exclude individuals</a> with a history of alcohol or drug abuse. It has been projected that drug availability to California residents alone will add $18 billion to health care costs in one year.</p> <p><strong style="color: #34405b; font-family: Arial, Helvetica, sans-serif; font-size: 12px; line-height: 20px;">The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our <a style="color: #000099; text-decoration: underline;" href="http://www.amc.edu/Academic/bioethics/index.cfm">website</a>.</strong></p>
June 6, 2014

To Properly Care for Veterans, Do We Really Need a VA Health System?

<p><span style="line-height: 22.399999618530273px;">The ongoing VA scandal is indeed unfortunate and sad. In a speech on May 30, 2014, in Washington, DC, <a href="http://www.nytimes.com/2014/05/31/us/politics/va-chief-eric-shinseki.html">Eric K. Shinseki apologized</a> for the “systemic, totally unacceptable lack of integrity” shown by some administrators in managing the Veterans Administration health care system hospitals and clinics. Within hours of the apology, Secretary Shinseki <a href="http://www.nytimes.com/2014/05/31/us/politics/eric-shinseki-resigns-as-veterans-affairs-head.html">resigned</a>.</span></p> <p class="MsoNormal" style="line-height: 22.399999618530273px;">It is clear that the trouble within the VA has been brewing for some time. The fuse that set off this latest explosion may have been <a href="http://www.azcentral.com/longform/news/arizona/investigations/2014/05/31/va-scandal-whistleblower-sam-foote/9830057/">whistleblower claims</a> that managers at the Phoenix VA Medical Center were keeping two sets of books which logged wait times for veterans seeking primary care appointments. There are allegations that some of the delays resulted in veteran deaths. Acting VA Inspector General Richard J. Griffin issued a <a href="http://www.nytimes.com/2014/05/29/us/va-report-confirms-improper-waiting-lists-at-phoenix-center.html">preliminary report</a> confirming that Phoenix VA administrators had manipulated wait times possibly to assure more favorable annual performance reviews and higher bonuses and compensation for staff.  The unethical behavior by those entrusted with the care of our veterans is inexcusable.</p> <p class="MsoNormal" style="line-height: 22.399999618530273px;"><strong style="color: #34405b; font-family: Arial, Helvetica, sans-serif; font-size: 12px; line-height: 20px;">The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our <a style="text-decoration: underline; color: #000099;" href="/Academic/bioethics/index.cfm">website</a>.</strong></p>
March 28, 2014

Fairness and a right to health care

<p>Amber is a 70 year old woman. She is doing poorly. She has metastasized cancer, multiple co-morbidities and a pressure ulcer. Apart from her ulcer, she has no acute care needs that condone her to the hospital. Some predict that she is likely to pass over in 3 months. With the right type of medications Amber could go home. However, the pressure ulcer medications that she needs cost about 200 dollars a day and she does not have the right type of insurance to pay for this. As a result, she is confined to a hospital bed. </p> <p>Amber has always contributed diligently to society. She worked from age 17 in a bank and paid her taxes diligently. Amber and her husband, who died 3 years ago, raised 3 children and lived in a town upstate New York. They used to take holidays on the West-Coast, where Amber has a family summer home.  This house belonged to her great grand-mother and has been in her family for 120 years. All of Amber’s family is attached to this house.</p> <p><strong style="color: #34405b; font-family: Arial, Helvetica, sans-serif; font-size: 12px; line-height: 20px;">The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our <a style="text-decoration: underline; color: #000099;" href="http://www.amc.edu/Academic/bioethics/index.cfm">website</a>.</strong></p>
March 7, 2014

GlaxoSmithKline and Conflicts of Interests

<p class="MsoNormal" style="line-height: 22.399999618530273px;">A <em><a href="http://www.nytimes.com/2013/12/17/business/glaxo-says-it-will-stop-paying-doctors-to-promote-drugs.html">New York Times</a></em><a href="http://www.nytimes.com/2013/12/17/business/glaxo-says-it-will-stop-paying-doctors-to-promote-drugs.html"> article</a> by Katie Thomas published on December 16, 2013 led with this sentence: “The British drug maker GlaxoSmithKline will no longer pay doctors to promote its products and will stop tying compensation of sales representatives to the number of prescriptions doctors write, its chief executive said Monday, effectively ending two common industry practices that critics have long assailed as troublesome conflicts of interest.” Might one ask: Are these really conflict of interests problems?</p> <p class="MsoNormal" style="line-height: 22.399999618530273px;">A <em>conflict of interest</em> (so sometimes, <em>conflict of interests</em>) is <a href="http://www.nejm.org/doi/full/10.1056/NEJM199308193290812">often defined as</a>: “a set of circumstances that creates a risk that professional judgment or actions regarding a primary interest will be unduly influenced by a secondary interest.”  In a short introduction to conflicts of interests, written for a business ethics class at the McCombs School of Business at the University of Texas at Austin, Dr. Lamar Pierce (Associate Professor of Strategy, Olin Business School, Washington University, St. Louis) said:</p> <p class="MsoNormal" style="line-height: 22.399999618530273px; padding-left: 60px;"><span style="color: #434343;">Incentives are pervasive in every aspect of society. People are rewarded for taking certain actions, and not rewarded for taking others. Workers are paid for their effort and productivity, salespeople are paid for their sales, and small business owners are rewarded with profits for successful ventures. So long as these incentives are well-understood by everyone, they work reasonably well. They motivate effort, performance, and social welfare. But sometimes, individuals have incentives that conflict with their professional responsibilities, often in ways that are not transparent to the public or in their own minds. These conflicts of interest produce serious economic and social problems.</span></p> <p class="MsoNormal" style="line-height: 22.399999618530273px;"><span style="color: #434343;"></span><strong style="color: #34405b; font-family: Arial, Helvetica, sans-serif; font-size: 12px; line-height: 20px;">The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our <a style="color: #000099; text-decoration: underline;" href="/Academic/bioethics/index.cfm">website</a>.</strong></p>