Major Moral Dilemma: It Started with Viagra

[coberst]

Major Moral Dilemma: It Started with Viagra

 

It is obvious even to the most casual observer (no Critical Thinking required) that we must quickly deal with the problem that medical technology has left on our door step. As a result of the success of medical technology we can prolong life ever more, every day, than the day before. I claim that this constantly extending the prolongation of life must quickly cease; we can no longer afford such a foolish unreflective behavior.

 

Bruce Hardy, a British citizen and cancer victim, was refused the funds, by British health officials, for a drug that could likely prolong his life for 6 more months. The drug treatment cost was estimated to be $54,000. His distraught wife said “Everybody should be allowed to have as much life as they can”.

 

“British authorities, after a storm of protest, are reconsidering their decision on the cancer drug and others.”

 

The introduction of the drug Viagra, by Pfizer, in 1998, panicked British health officials. They figured it might bankrupt the government’s health budget and thus placed restrictions on its use. Pfizer sued and the British government instituted a standard program, with the acronym NICE, for rationing health drugs.

 

“Before NICE, hospitals and clinics often came to different decisions about which drugs to buy, creating geographic disparities in care that led to outrage.”

 

“British Balance Benefit vs. Cost of Latest Drugs” New York Times

http://www.nytimes.com/2008/12/03/health/03nice.html?pagewanted=3&_r=1&hp

 

I have stated many times before that I was convinced that we have created a technology that is too powerful for our intellectually unsophisticated citizens to deal with. It seems to me that this particular dilemma does not require a great deal of sophistication to understand. This might be a perfect place to begin a nationwide (USA) Internet discourse directed at getting our intellectual arms around this problem and helping our government officials in an attempt to resolve this terrible dilemma.

 

Incidentally I am 74 years old, which I think qualifies me to push this matter without appearing to be a hypocrite.

[Eclogite]

I believe I qualify as a casual observer and, despite your assured claims to the contrary, it is not obvious to me that we must quickly deal with the problem medical science has dumped on our doorstep.

Could you begin, or rather continue, by defining exactly what it is you believe the problem to be. Is it the cost of drugs that proling life? Is it the difficulty of fairly distributing such drugs to persons who would benefit from them? Is it the very notion of extending life? Is it related to the quality of life that would be extended? Is it connected with the degree to which society is responsible for extending the life of the individual?

[coberst]

I believe I qualify as a casual observer and, despite your assured claims to the contrary, it is not obvious to me that we must quickly deal with the problem medical science has dumped on our doorstep.

Could you begin, or rather continue, by defining exactly what it is you believe the problem to be. Is it the cost of drugs that proling life? Is it the difficulty of fairly distributing such drugs to persons who would benefit from them? Is it the very notion of extending life? Is it related to the quality of life that would be extended? Is it connected with the degree to which society is responsible for extending the life of the individual?

 

You have succinctly delineated many of the important issues. I suspect many more could be added.

[Moontanman]

Well on thing i can see that needs to be addressed, insurance will pay to make an old man have an erection he can cut diamonds with but it won't pay for birth control to keep that old man from getting a woman pregnant. I think this definitely not correct from many angles not the least of which is over population and people having babies they cannot afford to take care of.

[Buffy]

:)

I have stated many times before that I was convinced that we have created a technology that is too powerful for our intellectually unsophisticated citizens to deal with. It seems to me that this particular dilemma does not require a great deal of sophistication to understand. This might be a perfect place to begin a nationwide (USA) Internet discourse directed at getting our intellectual arms around this problem and helping our government officials in an attempt to resolve this terrible dilemma.

 

Incidentally I am 74 years old, which I think qualifies me to push this matter without appearing to be a hypocrite.

 

You know, coberst, you spend a lot of time complaining about how people don't respect/dislike intellectuals, and then for some amazing reason, you wonder why?

 

Really, no one likes being called an idiot, and when some intellectual snob comes a long looking down his nose at them telling them what they ought to think and do *because* their idiots and need the smart people to "order their lives" you've got open hostility, yes, against intellectualism.

 

Need a mirror?

 

In my mind the real problem with the situation you pose is that investment in medical/pharmaceutical technology is problematic. Because there is almost no investment and promotion of the very expensive process of developing these technologies by the government--government regulations of course being the primary reason the process is so expensive. Although I'm firmly for the free market, I think that the government ought to provide more of the R&D budget in exchange for making sure that the resulting technologies don't end up costing an arm and a leg (literally!).

 

In many cases of pursuing intellectual decision making, it's important to actually consider Reframing the Problem, rather than blindly attacking the symptoms.

 

Always watch where you are going. Otherwise, you may step on a piece of the Forest that was left out by mistake, :)

Buffy

[coberst]

e obvious problem that comes to mind is how much of a nation’s health care budget can be allocated to the elderly to extend their life an additional 6 months. In 2003 the elderly accounted for one-third of all hospitalizations even though they represent 12% of the population. This cost was 43.6% of the nation’s health care expenditure.

 

Another important consideration is how can we limit the population to a reasonable level when we continue to extend longevity?

[questor]

Coberst, if I understand your question properly, could it be stated thusly: What does society owe a citizen during his life? Do we just owe people in our own country, or do we owe all of humanity?

If we are to owe others, what do they owe us? On the day Bruce Hardy was refused medication, probably thousands of people worldwide died because they had no medication for their

condition.

[Buffy]

There ya go: we should give everyone a fixed amount of health care dollars for their lives. When they run through that, then they don't get any anymore. Not even hospice care while they die.

 

Oh and those folks with congenital diseases? Tough luck! If it costs more than that amount to cure a 13-year-old, we should just let them die because its unfair to everyone else!

 

Why do you worry about us keeping the population to a "reasonable level?" While it looks like we'll easily hit 10 billion, the acceleration of births is actually slowing down as the biggest baby producing countries (China, India, and now even African nations) are starting to become developed countries? Certainly if you talk about developed countries only, we're on our way to flat growth discounting immigration, and some countries like Russia and Japan already have negative growth!

 

Life clocks are a lie! Carousel is a lie! THERE IS NO RENEWAL! ,

Buffy

[cooloola]

Buffy - that would be a particularly harsh world in which to live. There is a problem with funding and distribution no need to revert to this one size fits all policy.

[Turtle]

Buffy - that would be a particularly harsh world in which to live. There is a problem with funding and distribution no need to revert to this one size fits all policy.

 

:phones: I'm not a Buffy, but I play one online. :doh: Anyways, her coments are satire of the sardonic kind and refer to Questorator's implications in the post before which have a wider context here at Hypog in a number of other threads. To describe Questy's world-we-all-should-live-in as 'harsh', is apt if not an understatement.

 

I'm not forgetting you Cobersto, so as long as I'm here... :eek:

I claim that this constantly extending the prolongation of life must quickly cease; we can no longer afford such a foolish unreflective behavior. ...

 

I offer this: :phones: Science is the father of knowledge, but opinion breeds ignorance. ~Hippocrates

Hippocrates Quotes

[coberst]

Coberst, if I understand your question properly, could it be stated thusly: What does society owe a citizen during his life? Do we just owe people in our own country, or do we owe all of humanity?

If we are to owe others, what do they owe us? On the day Bruce Hardy was refused medication, probably thousands of people worldwide died because they had no medication for their

condition.

 

 

Mine is not so much a question as it is a claim that we face some very serious moral questions that requires answers constructed on a foundation of courage, compassion, and sophistication. How can we stabilize world human population in a moral and sophisticated manner and how to do we utilize our resources to best effect that important result?

[CraigD]

It is obvious even to the most casual observer (no Critical Thinking required) that we must quickly deal with the problem that medical technology has left on our door step. As a result of the success of medical technology we can prolong life ever more, every day, than the day before. I claim that this constantly extending the prolongation of life must quickly cease; we can no longer afford such a foolish unreflective behavior.

How do you propose to stop the advance or medicine and/or its application? (Therapies that prolong individual human lifespans must be termed advances in medicine and/or its application)

 

For such a thing to be possible, a profound characteristic of the relationship between the state/collective and the individual must exist: the wishes of the individual must be subordinate to that of the collective. This characteristic is not one of most states with representative constitutional governments, such as the US and the UK, who’s constitutions aim to assure that, outside of a few well-defined domains, the wishes of individuals concerning themselves take precedence over the wishes of others concerning individuals. For example, a government in the US may force a person to vacate and sell their home and property so that a road, a store, or even another home the government likes better may be built there, may punish an individual for injuring or killing another, but may not euthanize or otherwise require the death of a person who has, according to any criteria, lived too long, or consumed too many victual or medical resources.

 

In states with other forms of government, its possible that no such barrier to the prohibition of life-prolonging therapies exist. For example, in the hypothetical, fictional totalitarian state depicted in 1967 SF novel “Logan’s Run” (the source of Buffy’s “Carousel” reference), all citizens are ritually executed on their 21st birthdays.

Bruce Hardy, a British citizen and cancer victim, was refused the funds, by British health officials, for a drug that could likely prolong his life for 6 more months. The drug treatment cost was estimated to be $54,000. His distraught wife said “Everybody should be allowed to have as much life as they can”.

An important distinction must be draw between NHS’s denial of payment for Hardy’s treatement, and the UK denying him the right to have that treatment. Were Hardy’s family or another private party financially able and willing, their government would not prohibit them obtaining the treatment they wish for Hardy.

 

This raises another profound social issue, one that has figured prominently in US, UK, and other nation’s politics for the past century: what entitlements are owed to individuals by their states/collectives?

 

Unlike the previous question of state prohibition of life-prolonging therapy, which nearly all agree is illegal in the US and UK, there are many disparate opinions and implementations of policies concerning this question. The extreme “right wing” position holds that the state should be entirely uninvolved in the regulation, provision, and delivery of medical care, leaving the matter entirely to individuals and private businesses except to provide courts to settle disputes between disagreeing parties. The extreme “left wing” position holds that all individuals should be provided by the state with the best possible medical care. The UK, with its NHS, the individual states of the US with their Medicaid programs (despite having been enacted by and overseen by the US government, participation in and implementation of Medicare is voluntary to each state) and the US with its Medicare program (for the old and disabled) fall between these two extremes, with the NHS more toward the left wing extreme than the various US programs.

The introduction of the drug Viagra, by Pfizer, in 1998, panicked British health officials. …

Including its appearance in this thread’s title, the mention of Viagra strikes me as a non sequitur to the subject of life-prolonging medicine. Other than its possible psychological effect, Viagra is not a life-extending medicine. It is a medicine that aids men in achieving penile erections, enabling them to have, or have more enjoyable, sexual intercourse. Because both the pharmacological effects of the drug and the stress of sexual intercourse are actually potentially life threatening, Viagra is arguable a life-shortening drug.

 

Controversies over public healthcare agencies and private insurers covering or subsidizing the cost of Viagra since its 1998 introduction have been both newsworthy and financially significant. However, with Pfizer’s patent for Viagra due to expire in 2013 and the almost certain appearance of low-cost generic equivalents at that time, the financial significance will be much reduced then.

I have stated many times before that I was convinced that we have created a technology that is too powerful for our intellectually unsophisticated citizens to deal with.

Yet deal with it, and a host of other issues for which they often poorly prepared, citizens must, both the most and the least “intellectually sophisticated”.

 

A quarter century of professional experience in medicine has convinced me that intellectual sophistication, by its various most common measures, has little effect of the ability of individuals to make health care decisions concerning themselves. From the profoundly mentally handicapped to the most lauded academics of “both cultures”, nearly all people follow the advice of the clinicians treating them. Situations like Hardy’s, in which a patient disagrees with his clinicians, are rare.

 

More significant, in terms of the impact to quality of healthcare available to most people, is I think it the interaction between supply businesses - primarily major pharmaceutical companies, and to a lesser degree medical equipment manufacturers - and service deliverers - clinicians, hospitals, clinics and their administrative organizations, and, to a greater degree, medical colleges. This interaction, however, involves almost exclusively very intellectually sophisticated citizens - those with MDs, PHDs, and the performance-selected, frequently very educated elite of the advertising profession - so one cannot, IMHO, fault lack of sophistications for any detrimental effect it causes.

[coberst]

Craig

 

 

The Viagra comment came from the NYTimes article. Evidently the introduction of Viagra started a concern about how to control expenditures for health care. I included it in the title because it would attract many readers who otherwise would not have read my post.

 

My post is not to provide answers but to engage the consciousness of the reader to the basic problem. Mine is not so much a question as it is a claim that we face some very serious moral questions that requires answers constructed on a foundation of courage, compassion, and sophistication. How can we stabilize world human population in a moral and sophisticated manner and how do we utilize our resources to best affect that important result?

 

Citizens must be sophisticated enough to recognize the problem or they will never allow an answer to be formulated. Many of our problems cannot be solved because our citizens are not sophisticated enough to recognize them and thus will not permit a solution until they face the abyss. Often when the abyss is here the solution is too late.

[questor]

Turtle, I would describe my opinions as realistic rather than harsh. If there was an infinite amount of

money, oil, water, air, medicine and all the things that human beings use for their lives and pleasures, we would not need a conversation on these issues. There would be no need for conservation or refusal of treatment or sparing of expense for anyone who needs something.

I do not see infinite resources. I see limitations by nature, finances, age, general health, and future expectations for individuals. If something is limited to a number of two and five people will die if they don't receive it, how does one make the choice?

[questor]

A comment on the ''morality'' of this problem. To my knowledge, there are no moral animals except human beings. There are animals who care for their pack or pod, and who seem to grieve for their brethren, but can this be described as morality? The human being alone has the capacity to recognize and try to wrestle with questions of morality. Is this a blessing or a curse? Sympathy and empathy are laudable traits, but can they go too far? Dr. Death (Kervorkian) served several years in jail for asssisting terminally ill people to end their lives? Would it have been better to let these people die a long and painful death with no chance of living a normal life, with no dignity or hope, and depleting their families savings, or would it be better (with the patients aquiescense) to terminate their lives? For myself, I would prefer to die without torturous pain and with dignity. With people living longer and dying of the more painful degenerative diseases, what is the moral ground, and what does society owe to its citizens? How much should we spend to prolong the life of a person over 75 if it depletes the opportunity to save younger people?

[CraigD]

How can we stabilize world human population in a moral and sophisticated manner and how do we utilize our resources to best affect that important result?

I think the answer to this question has long been settled: the best way to regulate population change is by controlling the birth rate. for example, starting in 1979, the government of the PRC used a program of economic disincentives (a “2rd (or 3rd) child tax”) to effectively reduce their rate of population growth. Although many question how effective this program actually is, suggesting widespread census fraud resulting in systemic population, underreporting, most consider the this program to have been instrumental in having produced the high average savings rate that has made the PRC such a successful exporting and foreign investing state.

[Turtle]

Turtle, I would describe my opinions as realistic rather than harsh.

That's only natural. Shall we simply agree harsh realities sometimes exist? That way we won't have to start parsing the terms ad nauseum. :eek:

 

Sympathy and empathy are laudable traits, but can they go too far? Dr. Death (Kervorkian) served several years in jail for asssisting terminally ill people to end their lives? Would it have been better to let these people die a long and painful death with no chance of living a normal life, with no dignity or hope, and depleting their families savings, or would it be better (with the patients aquiescense) to terminate their lives?

 

'Patients' can always terminate their lives, whether it's with Dr. D's machine or a revolver. Now as we are talking about governments role in all this, my state of Washington, following Oregon's landmark law, passed a Death with Dignity law that allows terminally ill patients to get a subscription for lethal meds to end their lives. >> Welcome - Death with Dignity National Center

 

The legal problem as I see it with continuing the way we do is that suicide is illegal most places and while the dead guy/gal has no more worries the family may loose insurance or encounter other legal impediments. :naughty:

 

I still don't like the flavor of your parenthetical "(with the patients aquiescense)", as it appears as if an afterthought, as well as seems to imply the 'patient' may be petitioned to take their lives rather than they being the petitioner.

 

Anyway, interesting stuff to entertain, Viagra induced or not, and I remain your humble, but harsh, critic.

 

All, too, will bear in mind this sacred principle, that though the will of the majority is in all cases to prevail, that will to be rightful must be reasonable; that the minority possess their equal rights, which equal law must protect, and to violate would be oppression.

Thomas Jefferson

:cheer: