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Advances in genetic testing are increasingly giving families with bad genes a chance to see the future, sometimes with the hope of pre-emptive action. People have had stomachs, breasts, ovaries, colons or thyroid glands removed when genetic tests showed they carried a defective gene that gave them a high risk of cancer.
Story here.
With regards to this post, a student recently argued that economists are moral relativists, and, like economic arguments supporting the decriminalization of drug use, there may be moral and ethical reasons for restricting things like drug use and markets for organs. Forget the fact that this student probably meant that economists are consequentialists (although I presume some are indeed moral relativists), her argument raises a valid concern. Maybe many do believe that a market for organ donations is morally repugnant and we as a society should therefore prohibit the sale of organs. That is a valid position based on tastes of moral and ethical principles, and we know that "de gustibus non est disputandum."
My only reply is the following. Would you accept the position that there should not be a market for organ donations if your mother or child or sibling needed an organ transplant and would have a high likelihood of dying before The United Network for Organ Sharing found one? What if it was you needing an organ? What if you knew today that if you someday found out you needed an organ transplant it would be too late to petition Congress in time to repeal its law against organ sharing in order to obtain one before you die?
Moral and ethical concerns are certainly valid, but we must also consider the costs of specific laws. And we ought to consider such laws behind a Rawlsian veil of ignorance.
Update: By the way, it's because of this last sentence that I am understanding of arguments for criminalizing recreational drug use, but much less so for arguments prohibiting markets for organ donations.
In defense of the Caplan-Hanson theory that the margin of wasted medical expenses is large.
The Times found that:
• Pharmaceutical firms have commandeered the process by which diseases are defined. Many decision makers at the World Health Organization, the U.S. National Institutes of Health and some of America's most prestigious medical societies take money from the drug companies and then promote the industry's agenda.
• Some diseases have been radically redefined without a strong basis in medical evidence.
• The drug industry has bolstered its position by marketing directly to the health-conscious consumer, leading younger and healthier people to consider themselves at risk and to start taking medications.
Every time the boundary of a disease is expanded — the hypertension threshold is lowered by 10 blood-pressure points, the guideline for obesity is lowered by 5 pounds — the market for drugs expands by millions of consumers and billions of dollars.
The result? Skyrocketing sales of prescription drugs. Soaring health-care costs. Escalating patient anxiety. Worst of all, millions of people taking drugs that may carry a greater risk than the underlying condition. The treatment, in fact, may make them sick or even kill them.
And further down:
Treatment guidelines established by international and national health organizations instruct physicians on diagnosis and treatment of disease and are meant to be scientifically pristine. But many of those groups lack any process for preventing or disclosing conflicts of interest.
The Times found that for a broad spectrum of diseases, the experts writing the treatment guidelines had drug-company ties ranging from research contracts to consultancies to stock ownership.
What!? Rent seeking in the medical profession?
Link via Fark.
How have the medical sciences improved the human condition throughout the twentieth century?
Although the Avian flu poses a serious global threat, the likelihood of dying from killer viruses has been largely curtailed.
Here's a blog dedicated strictly to the Avian flu.
Pharmacists in some states may refuse to fill perscriptions on moral and ethical grounds. It seems Canadian hospitals can refuse to conduct an organ transplant on those same grounds, albeit for different reasons.
Baruch Tegegne, 61, has dialysis treatment four times a week and has needed a kidney transplant for a year. None of his relatives are compatible donors.
Rather than waiting on a transplant list with 3,000 other Canadians, a friend, documentary filmmaker Simcha Jacobovici, put an ad on a website pleading for a donor.
In late February, a man in India responded to the ad and offered Tegegne his kidney.
Royal Victoria Hospital refused to perform the operation on the grounds that it could not be sure the man was not being paid under the table for his organ.
There is a moral hazard problem if there is a market for organs, and it is also difficult to determine when a kidney is freely donated and when the donor is being coerced. Lifesharers seems a good alternative, although I have heard some debate about the legality of this program as well.
But why didn't Tegegne just go to India to get the transplant done?
A letter from the Moncton Hospital to a New Brunswick heart patient in need of an electrocardiogram said the appointment would be in three months. It added: "If the person named on this computer-generated letter is deceased, please accept our sincere apologies."
Story here, and it's worth reading the whole story.
But it's this type of thinking that institutes such a heartless and inefficient programs.
Despite the financial burden, Canadians value their Medicare as a marker of egalitarianism and independent identity that sets their country apart from the United States, where some 45 million Americans lack health insurance.
Raisa Deber, a professor of health policy at the University of Toronto, believes Canada's system is one of the world's fairest.
"Canadians are very proud of the fact that if they need care, they will get care," she said. Of the United States, she said: "I don't understand how they got to this worship of markets, to the extent that they're perfectly happy that some people don't get the health care that they need."
"[G]et the health care that they need."? That's the problem; health care, like any good or service, suffers from scarce resources and has to be rationed in some manner. Nationalized medicine simply supplants the market, where entrepreneur doctors better serve the interests of their customers or face losses, with the values of a careless political and bureaucratic institution that suffers no harm should it fail to serve its "customers' needs.
Those 45 million uninsured in the U.S. (many are recent immigrants into this country) receive medical attention, and in a timely manner. When I discovered a mole that turned out to be malignant melanoma three years ago it was biopsied and excised within two weeks. How does Canada's system compare?
Meanwhile, the average wait for surgical or specialist treatment is nearly 18 weeks, up from 9.3 weeks in 1993, according to the Fraser Institute, a right-wing public policy think tank in Vancouver. A Fraser study last year said the average wait for an orthopedic surgeon was more than nine months.
India offers an affordable alternative.
Trent McBride is hosting a session of Ground Rounds at Catallarchy.net. Although I have not known of Ground Rounds until Trent apprised me of its existence, it appears to be a weekly session of posts related to medical issues by (mainly) medical students. Trent hosts this session with posts mainly by non-medical students or related professionals, focusing mostly on economic ways of thinking about medical care.
It's a good read.
Why does it cost on average $800 million to bring a new drug to market?
But most medicines in clinical trials are likely to fail. Only one in 5,000 of the compounds invented in drug company labs is thought to make it into patient testing at all. And according to the Tufts Center for Drug Development, only one in five of those medicines that does get tested in humans ever makes it to market at all.
The beneftis of this testing are enormous. Click on any of the diseases under "New Drugs to Watch," to see the drugs currently in various testing stages.
Julian Simon once noted that at the turn of the twentieth century you had a 50:50 chance that the advice a doctor gave you would do you more harm than good. Now I believe that within my children's lifetime certain cancers will be curable.
It turns out that melanoma, the most dangerous type of skin cancer, involves melanocytes, the cells that help color hair and skin.
So researchers at the Dana-Farber Cancer Institute in Boston decided to investigate what happens when these cells become depleted, allowing hair to go gray.
``Preventing the graying of hair is not our goal,'' said senior researcher Dr. David E. Fisher. ``What we really want is to come up with treatments for melanoma.''
Update: Dave points out my error made in haste: certainly cancer is curable now with earlier detection methods and radiation and chemotherapy, making death from most forms of cancer much less common. What I meant to say was that these trends will eventually make it so that death from certain forms of cancer will be unheard of.
blogging on my laptop while hot tubbing in my tightie whities.
Elevated scrotal temperatures have been linked to male infertility. Many factors can raise scrotal temperature, including hot baths, saunas, and tight jockey shorts.
Laptop computers may also belong on that list, say Sheynkin's team. They studied 29 healthy young men ages 21 to 35 for two, one-hour sessions in a climate-controlled room.
Scrotal temperature rose with the working and nonworking computers. However, the working laptops prompted a greater increase in scrotal temperature -- around 37 degrees Fahrenheit on both sides of the scrotum (2.8 degrees Celsius on the right and 2.6 degrees Celsius on the left).
Participants without working laptops had a scrotal temperature increase of just under 36 degrees Fahrenheit (2.1 degrees Celsius).
Whew! Fortunately, I use a Mac Powerbook and sit Indian-style. (Is it okay to still say "Indian-style"?)
The researchers used two brands of Pentium 4 laptop computers. The brands aren't identified in the study, which appears in the European journal Human Reproduction .
Technology doesn't deserve all the blame. The position required to balance a laptop computer in the lap -- with thighs close together to balance the computers -- also increases scrotal temperature. Still, the heat generated by the laptops adds to the problem.
In the study, the bottom of the laptop computers rose from about 88 degrees Fahrenheit (31 degrees Celsius) to almost 104 degrees Fahrenheit (40 degrees Celsius) after an hour. Both brands had similar temperature increases.
"Working on laptop computers in a laptop position causes significant scrotal temperature elevation as a result of heat exposure and posture-related effects," say the researchers.
Update: Just in case it wasn't obvious, my comments are meant as a joke. I take this study to be a joke, notwithstanding the serious nature of the subject.
