Bioethics

From a religious standpoint, is modern biotechnology to be interpreted as “playing God” or as collaborating in the on-going work of creation? ~Dr. Gurinder Shahi

The above question expresses an important ongoing bioethical debate. Within many religious traditions, ultra conservatives often see modern biotechnology as playing God. In-vitro fertilization (IVF), genetic engineering, and other medical interventions have been argued to be playing God. Along this line of argumentation, Jehovah’s witnesses do not accept blood transfusions, for example. However, other less conservative individuals of major religious traditions see humans as co-creators. That is, God endowed man with the mental capacity and resources to address new problems in novel ways. Francis Collins, for example, is an evangelical Christian and head of the Human Genome Project who reconciles modern science and Intelligent Design (see Language of God).

In certain cases, the line of what is acceptable to members of various religious traditions becomes hazier. For example, In-vitro fertilization (IVF) with donated oocytes allows infertile women to become pregnant in their sixth decade of life (see Dr. John Jain’s work at USC). I tend to agree with the co-creator camp. However, I feel that certain biotechnological innovations are unethical, as in the above case. What do you think?

Business ethic vs. human ethic

YouTube video Private Medicine is evil? raises a number of criticisms about the private healthcare system in America. Of particular interest to me is the argument expressed in the closing statement: “Profits for human life in my mind is evil.” What I think he means here is not necessarily that people and organizations shouldn’t profit for helping people, but rather that not helping those who cannot afford care is wrong. It’s important to distinguish between his explicit statement here and his larger argument. The narrator’s problems are that 1) large private corporations have been socially irresponsible, and 2) when financial incentives are the driving force of healthcare, glaring disparities often arise.

I tend to agree that universal healthcare is a more socially responsible approach (while some large corporations such as the Bill & Melinda Gates Foundation, have taken seriously their responsibility to give back to society, not all large corporations have been so altruistic) but I believe that present capitalistic values hinder the enactment of such a policy in America and elsewhere. A big concern of mine is the effect of the exportation of American capitalism on foreign cultures and economies—particularly when private approaches are not partnered with public entities that protect the health and economic interests of all those impacted. This is somewhat different from the argument for universal healthcare, as described above, but the underlying skepticism about capitalistic enterprises rings true in the case of providing quality of care in developing countries as well. With western values the way they are today, there is a tension. If we want to move towards a more socially responsible society, business ethics cannot replace the more overarching human ethics.

Healthcare Financing in Texas: Case Study

An article in the NYTimes illustrates part of the problem with healthcare financing in America today. Dee Dee Dodd is a 38 year old woman who lives on a country road in Hays County, Texas. Among the working poor, the Dodd family makes too much money to qualify for Medicaid under stringent Texas laws (if a working parent of two or more makes more than $3696 a year, he or she is ineligible). With between 150-250% of the federal poverty limit, the Dodd family cannot afford private health insurance. Ms. Dodd was diagnosed as a “brittle diabetic” ten years ago when her weight fell to 82 pounds. Years of low access to health care had weakened her and led to preventable side effects like esophageal ulcers. Additionally, repeated episodes of ketoacidosis were life-threatening. In one 18-month period, Ms. Dodd accumulated over $191,000 in unpaid hospital bills for emergency room visits and time spent in the intensive care unit. As a result, Ms. Dodd was classified as a “frequent flier,” or a repeat patient whose disease and expenses could be decreased with more regular medical care. The Seton Family of Hospitals enrolled Ms. Dodd in their charity program, where she now receives free primary care. The use of a $3,200 insulin pump and access to an endocrinologist and home counseling have helped reduce the severity of Ms. Dodd’s ailments. Her health has improved, her medical bills have been cut, and the hospital’s costs have been cut as well. In 18 months, her care cost Seton $104,697—significantly less than the previous period when Ms. Dodd was not a part of Seton’s charity program.

For individuals with chronic conditions, better care not only decreases disease, but may also decrease patient and hospital costs. Seton's charity program is among others that have taken novel approaches to curb hospital costs in Texas. Recognizing the many problems with healthcare financing in America today, states are taking the lead on developing plans that better address health/financial/ethical complexities. One recent example is Massachusetts’ plan to have 99 percent of adults covered by health insurance. With healthcare financing on the state and national agenda, it will be interesting to see how things change within the next decade.

Terrorist incidents: has public awareness increased response preparedness?

Among the man-made disasters, one has received increased attention in the minds of the western world: terrorist incidents. One BBC video clip entitled “The Power of Nightmares,” argues that in the past, politicians offered dreams to the people. As people have lost faith in these ideologies, politicians are seen increasingly as managers of public life rather than as visionaries. Instead of offering dreams, politicians have restored a sort of prominence by promising to protect us from nightmares: Dreadful dangers we do not see or understand… international terrorism with vast networks. The journalist in the clip argues that such threats have been exaggerated and distorted by politicians.

There is a definite need in society to have infrastructures in place for multi-sectoral responses to devastations if and when they occur. The threat of terrorist incidents is a relatively new challenge that theoretically requires a number of the same considerations as other large scale threats (for example: war, natural disasters, and severe weather). Because there is a prospect that terrorist incidents could result in mass casualties or devastation to socioeconomic functioning, such threats do need monitoring, surveillance, and rapid response. Currently, new policy measures and military activities have taken steps towards responding to the threat of terrorism. While such steps are proactive, I have many concerns with the breadth and depth of our approaches. Most importantly, I am of the mind that this should be one of our lesser concerns in terms of potentially devastating threats. While on the agenda, disease outbreaks and natural disasters receive less public attention than terrorism and may in reality pose more of a threat to American citizens.

As is the case for other threats, public awareness is one way to better response capabilities within the population. As a basic example, educating individuals what to do if an earthquake is felt, and what provisions to have within the home have increased earthquake preparedness. But what has been the benefit of widespread public attention to terrorist threats? Politicians’ image is developed as our protectors from terrorism and the media cashes in, but what other (and whose) interests are served? Are we as individuals better off due to the media exposure, for example?

***With tremendous public awareness about terrorism, are we more prepared if something happens, or has a culture of fear pervaded our society? ***

I will close this week’s blog by encouraging you to watch a hilarious 16 second clip entitled “fear of terrorism.” Cheers.

You know the world is going crazy when...

"You know the world is going crazy when the best rapper is a white guy, the best golfer is a black guy, the tallest guy in the NBA is Chinese, the Swiss hold the America's Cup, France is accusing the U.S. of arrogance, Germany doesn't want to go to war, and the three most powerful men in America are named Bush, Dick, and Colon."

- Chris Rock

Technology and quality of life. Are we better or worse off?

I’m going to be all over the place in this blog entry, so try to stay with me…

For starters, I found the following Ancient Chinese Curse quite poignant for several reasons: “May you live in exciting times.” Individually, I feel inclined to a peaceful life—one that is not marked by long hours, competition, and high stress. However, I was born into an era where increasing technologies and globalization have made peace something to look forward to during retirement, rather than integrated into the daily lives of the general western population. We may live during exciting times, but do we live better lives because of it?

Admittedly, technologies have made the lives of individuals within the developed world abundantly more comfortable. However, with increasing access to the world around us, has our quality of life significantly increased? Undoubtedly yes… in some areas. BUT—I still find it incredibly ironic that 1) urbanization has placed so many people in such close proximity, 2) technologies have made it so that if we want to contact some one we have a plethora of resources at our disposal (call, text, e-mail, skype, facebook/myspace message, fax, etc, etc… or meet in person) and 3) we are marked as one of the loneliest cultures in history.

I guess what I’m saying is that I question some of the associations between increasing technologies and their effect on psychosocial behavior & well-being.

Nonetheless, the technological revolution offers considerable promise in the arena of public health. Particularly, gadgets can be used to monitor health status (or track disease maintenance) continually and thus provide a way for preventive medicine to enter into mainstream western medicine. Such breakthroughs offer the most immediate promise to those with chronic disease as well as aging populations. Continual health surveillance means that patients can be managed out of the hospital. When heart rate fluctuates abnormally, or cholesterol increases beyond a given value for example, steps can be taken to address the problem before there is a devastating (and expensive) medical emergency. As technological breakthroughs occur, methods to promote health, prevent disease and even treat disease will continue to change the medical infrastructure and the way that we perceive personal health. Such alterations also promise to change the way we live our lives…

Will the outcomes of such breakthroughs better or worsen our quality of life? Will we become like machines, fine-tuned to be healthy and to continuously compete in the international marketplace? Or can we find a balance—utilizing technologies to better health without being consumed by the impersonal matrix of technological advancement? (Human advancement???)

Will such trends further delineate the world’s rich and poor? There are just so many questions and such heavy baggage that this topic brings to the table. Nonetheless, we cannot avoid such questions because this topic will continue to define the world we live in. We must strive to use technologies—medical, informational, communication, etc.—as a tool, rather than as an end.

Public entities as consumer of high cost innovations

Both pharmaceuticals and technological innovations require high R&D expenditures, both offer novel ways of addressing healthcare concerns, and the patterns of adoption may be compared (although the channels of adoption may be somewhat different). A NYTimes article caused me to consider some of the financial considerations regarding innovations relating to healthcare. This article focuses on novel cancer drugs. While they provide new hope for the treatment of cancer, they do so at a high patient cost and at a high cost to society.

In a lecture with a physician and administrator for Los Angeles County healthcare, I became aware of some ethical concerns associated with these trends. In particular, the high cost of cancer drugs (and novel technologies) not only affects the patient/consumer and his/her insurance, but also the taxpayer. Expensive innovations are not only bought by private organizations, but by public ones as well. As such, issues of distributive justice arise. Should the uninsured have access to novel technologies even when this means less resources for other patients, or other hospital departments? Who should decide how the taxpayers money is spent on various innovations relating to healthcare? When the efficacy of these innovations is limited, but beneficial nonetheless, how does this effect what should be considered the appropriate degree of utilization by public entities?

For arguments sake: what if there was a new vaccine that could cure diabetes, but cost $100,000 per shot. Who should have access to the vaccine that can’t pay for it on his or her own? If the government can buy a certain amount, what is the ethical distribution? What if the vaccine is known to be 20% effective; how does that alter the utilization by publicly-funded hospitals?

As the cost of technological innovations increases, can public entities afford to be a major consumer to the detriment of other types of purchases?