Archives for posts with tag: philosophy

It comes to mind that this should be a field day for moral philosophers, or at least those in the Aristotlean mode who like to talk about categories of virtue and what not.

Look here! We have the idiotic evil incompetents (Trump and Bannon), the principled (but evil) organizational men, doers and organizers (Ryan and McConnell), the spineless collaborators (Rubio and Chaffetz), and the unscrupulous greedy connivers (Jared). We have the passive self-justifiers (Collins), the tragic-comic bumblers (Christie), and the self-aggrandizing demagogues (Stein). We have the earnest electoral failure (Clinton) and the distant hero (Obama). We have the safe champions (Gilibrand) and the fierce persisters (Warren).
Which is the worst evil? Which is the greatest good? Let the learned speculation start!

Multifaceted philosopher Hilary Putnam has died. In 2008, I interviewed him for the Jewish Forward on his approach for religious thought. 12821510_1194112173934389_7934087212595550885_n

I went to a great talk this week at the Berman Institute of Bioethics, and I’ll try to summarize it accurately (any felicities are the speaker’s, any errors mine). The speaker was Matt DeCamp, a friend of mine who – among other virtues – is enviably trained with a PhD in philosophy together with his MD. The bioethical question is this: how are we to understand the tradeoff between present costs and future benefits in the context of new drug development?

To understand this question, one needs to be acquainted with pharmaceutical R&D. It takes quite a bit of money, about $1 billion, over 10-12 years, to bring a drug to market. Drug companies make the most money of their product in the first 8-10 years after approval, after which time there is either voluntary price reduction on the part of the manufacturer, or a number of generics.

There are incentives provided to these manufacturers to invest in new pharmaceuticals. Familiar to most are patents (or copyrights/trademarks) which grant protection from copying and therefore a monopoly. Less familiar is data exclusivity, under which (according to Federal law) companies are prevented from marketing a product based on the same clinical data for 5 years. This grants a monopoly even if no patent exist.

Data exclusivity, it turns out, brings significant economic value with it for the company. I won’t go into detail, but Matt brought the examples of Glucophage and Colcrys.

“Health care reform” (PPACA) proposed a 12-year exclusivity for biologics. Matt then took the case of three people he made up, members of three different but overlapping generations.  How much can we ask of the oldest generation, who pays for this exclusivity without reaping the expected benefits? This is a separate ethical question (and this was one of the central points of the talk) from intergenerational justice with regard to distant generations.

For overlapping generations – e.g., members of generations who are living today, but older/younger than others – the questions are how to balance short-term costs and benefits, and not to lose sight of the fact that, while an individual proposal might be cost-neutral in the medium to long term (e.g. data exclusivity extended to 12 years), its short-term effects might fall disproportionately on certain age groups.

Should the oldest generation be expected to pay in more than it takes out? Matt’s argument was no – briefly, that a human right to health would be left unfulfilled if access to certain medicines is part of this right to health, and if costs unfairly fall in disproportionate fashion on certain groups.

Different concerns obtain, however, in thinking about distant generations. (Here he referenced the non-identity problem; briefly, can we expect, or assume, that our actions will have an affect on future individuals? This is relevant, apart from philosophical concerns, because some hold that human rights are not a property of groups, but properly only of individual human beings.)  If we are uncertain what will happen in future generations, or if we cannot accord them the assumption of identity, can we – our current generation – trade away a future generation’s right to essential medicines?

Balancing our present needs against future generations’ needs requires, Matt said, addressing several thorny questions: the value of a human life; the social discount rate; and the health discount rate. In any case, we need to accept either that future generations do not have rights, and priority should be placed on access now – or that they do have such rights, and we need to work on the tricky balancing act.

Matt closed by mentioning a number of radical policies which might mitigate, but not eliminate, the issue of intergenerational justice. These have to do with eliminating data exclusivity, to “allow immediate generic production, which would lower prices and increase access today, which could force more widespread social dialogue about intergenerational justice.” 3 alternatives he mentioned to monopolistic pricing are prize funds, advanced market committments, and public funding of clinical trials. He also mentioned less radical options, and counseled attention to intergenerational justice and the assumptions involved in calculating future risks and benefits.

This is an incomplete summary of his talk, which I hope to see in article form soon (in particular I left out graphs, figures, and health-economics language). He set a high bar for my own talk at the same seminar series, which I am giving next month.

“While Marxists have been most vocal in raising the issues of “false consciousness,” and “true versus false needs,” it is important to see that the question is one which a wide range of social theorists must address. For it is a reasonable feature of any good society that it is self-sustaining in the sense that people who grow up in such a society will acquire a respect for and commitment to the principles which justify and regulate its existence. It is very unlikely that the development of such dispositions is something over which individuals have much control or choice. Socialization into the norms and values of the society will have taken place at a very young age. It looks, then, as if we can only distinguish between institutions on the basis of what they convey, their content, and not on the basis that they influence people at a stage when they cannot be critical about such matters. It looks, therefore, as if autonomy in the acquisitions of principles and values is impossible. ”

–Gerald Dworkin, The Theory and Practice of Autonomy.