Sunday, August 3, 2014

Dying for Medication and Politics

Stop and think for a moment and consider this scenario from the work of Lawrence Kohlberg:


"A woman was near death from a special kind of cancer. There was one drug that the doctors thought might save her. It was a form of radium that a druggist in the same town had recently discovered. The drug was expensive to make, but the druggist was charging ten times what the drug cost him to produce. He paid $200 for the radium and charged $2,000 for a small dose of the drug. The sick woman’s husband, Heinz, went to everyone he knew to borrow the money, but he could only get together about $1,000 which is half of what it cost. He told the druggist that his wife was dying and asked him to sell it cheaper or let him pay later. But the druggist said: ‘No, I discovered the drug and I’m going t make money from it.’ So Heinz got desperate and broke into the man’s store to steal the drug for his wife. Should Heinz have broken into the laboratory to steal the drug for his wife? Why or why not?”

Is it ever OK for Heinz to take the medicine, especially since the druggist is making such a huge profit and Heinz has offered to pay for just a little of the drug? Should he consider that taking it without payment would be illegal or should he allow his wife to die and do the honest thing and not steal the drug? How would you argue here? 

Perhaps it resonates with some of my readers because there are medications which are now coming onto the market which are extremely expensive but which could have life-saving qualities. Some cost as much as $1K for a single pill and patients, obviously, would need more than one pill for their disease.  The year of treatment with that extraordinarily expensive pill is estimated around $84K. Is one life worth that much, you may ask? What is a life worth? Are some lives worth more than others or is every single one worth an incalculable amount? Ask anyone who has a dying child and see what they would answer.

These life-saving medications and the dilemma they present to those who can't afford them or whose healthcare coverage doesn't reimburse for them are real life-and-death and quality-of-life issues for many people all over the world.  Insurance pays for medications categorized as "lifestyle" aids (read that Viagra) but not for anything that could be lifesaving but deemed "experimental." If it saves a life, should it still be "experimental?"

This isn't just a problem of healthcare and reimbursement for those of us here in the U.S. It affects every single person on this planet because we are,  as John Donne wrote: 

"No man is an island,
Entire of itself,
Every man is a piece of the continent,
A part of the main.
If a clod be washed away by the sea,
Europe is the less.
As well as if a promontory were.
As well as if a manor of thy friend's
Or of thine own were:
Any man's death diminishes me,
Because I am involved in mankind,
And therefore never send to know for whom the bell tolls; 
It tolls for thee."

The question now becomes, if there is medication for an illness which could cause death in other countries, too, will the sudden rescue of those individuals be altruistic or self-serving? Either way, common sense tells us that, as part of the main, we should care for everyone on it, but we don't, do we? Ebola is rampant in West Africa and there is great concern, nay fear, that it may spread to Great Britain or the U.S. You've read the statements by prominent pseudo thought leaders or wannabe political candidates that we shouldn't allow anyone into the U.S. who has this deadly killer.

The fear of disease is being so pumped up, even in the face of medications that can prevent or cure many illnesses, that it is being used as a political ploy to keep immigrant children from entering our country. Turning back the children reminds me of something I once read about FDR, our revered and reviled deceased President, who kept to the Jewish quotas for the U.S. and who turned back ships escaping from the European killing camps of Nazi Germany. How many perished because of his inaction? How many children will die if they are sent back? 

I never thought of plague or any disease as a political weapon but I can see how anyone's fear can be manipulated. If Heinz' wife had an infectious, communicable disease, would the druggist have refused her or would the government have stepped in to save all of us? It's really a matter of self-preservation, isn't it? If you have a disease and you can't afford the medication for effective treatment and the disease won't spread to the rest of us, well, of course, you'll just have to grin and bear it and try to make something positive out of it. If, on the other hand, you have a disease that we could catch and which might kill a lot of us, we will, of course, save you and, in the process, ourselves. 

So, be careful what diseases you catch or develop and be sure it's one that will bring panic to the authorities so that they will cover you for the medication you need. It's really as simple as that.

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