Engineering Ethics Blog: What Price Medicine?


Last week I had the privilege of attending
the American Physical Society Texas Section’s annual regional meeting, held
this year at the campus of the University of Texas at Dallas.  Among several invited speakers was a
professor of radiology who spoke about the latest medical imaging techniques
being developed for observing biological activity on the molecular level. 

As interesting as that was, I want to focus
on an offhand remark the speaker made. 
He has many friends in the medical research community, among whom is one
who has been doing cancer research with rodents.  His friend has found that if rodents who have cancer are fed
ordinary bicarbonate of soda (the same kind you can get in the Arm & Hammer
box at the grocery store), the alkalinity it adds to the animal’s body
chemistry is enough to stop the cancer from metastasizing. 

That’s not what I want to focus on
either.  What I want to highlight
is what the professor of radiology said next about his friend’s discovery:  “It’s too bad in a way, because,
you know, there’s no money in it. 
But I still think he’s on to something.” 

Why is there no money in a cure for cancer
that would use a substance that is not patented and costs a couple of dollars a
pound?  Asked that way, the
question almost answers itself.  On
the other hand, if some exotic and patentable chemical was found to do the same
thing, it would probably be in clinical trials on humans by now.

The way the pharmaceutical industry in the
U. S. and most other industrialized countries works is roughly this.  The firms spend millions of dollars on
research directed at finding new drugs.  So far so good. 
But not just any new drug: 
a new drug that will be at least moderately effective against a malady
that requires the drug to be taken indefinitely.  In this way, the company can recoup its investment over the
lifetime of the patient as well as the lifetime of the drug’s patent. 

Because it is potentially so profitable,
this mode of operation has squeezed out other ways that drug companies could
work.  If a drug is found that
cures a disease with one dose, or if a drug’s patent expires and the company
can’t find a way to extend it, or if a drug turns out to be something that
can’t be patented in the first place (such as bicarbonate of soda), then the
drug companies aren’t interested. 
And because the companies have become such a dominant force in the research
community, drugs and treatments that don’t fit their profitability pattern are
increasingly ignored and neglected. 

The companies defend their ways of doing
things with the claim that modern pharmaceutical research is costly, and if
their markets are controlled or supervised with governmental interference, it
will be like killing the goose that laid the golden egg.  All drug innovations will cease and
we’ll be back to using leeches and bloodletting.  That’s an exaggeration of their attitudes toward regulation,
but only slightly.  And they do
have a point:  the business model
they have adopted is indeed costly, but when it works, it’s extremely
profitable and attracts investment capital, without which nothing much could be
done, at least in the private sector. 

That is one model of healing.  Another model is that of Mother
Teresa.  The famed founder of the
Missionaries of Charity dedicated her life and the lives of her nuns to the
service of the poorest of the poor in Calcutta, India, and ultimately hundreds
of other places around the world. 
Their financial system, if you can call it that, would give an
accountant nightmares.  They will
take donations from anyone—foundations, governments, individuals, even
criminals—and spend it right away on the most urgently needed items for the
people they serve.  Many of the
people they help are dying anyway, but to the dying they bring companionship,
hope, and love. 

The work of the Missionaries of Charity has
not led directly to the invention of a cure for any disease.  It has not made anyone richer
financially.  But it has added to
the store of human capital in the form of good works and examples of how to
live.

As long as sickness and the other
consequences of the Fall of Adam and Eve are with us, there is going to be a
tension between these two ways of healing.  In The Abolition of
Man
, C. S. Lewis portrays a contrast between two ways of approaching the
world.  One way is to view nature
as simply raw material to be fashioned according to our will or whim.  Another way is to learn from nature
what the universe is about, and conform our actions and behavior to what Lewis
calls the Tao, the set of perennial principles of right and wrong common to all
times and peoples. 

Both the Missionaries of Charity and Big
Pharma do good things.  Without the
Missionaries, thousands of sufferers in desperate straits would live and die
unloved and uncared for.  And
without Big Pharma, many medical conditions ranging from the fatal to the
trivial would go untreated, and many investors would have to find something
else to do with their money.  In
the debates about the U. S. Affordable Care Act, experts have proposed many
kinds of large-scale plans and changes that would allegedly make things better
somehow.  But they are all complicated,
because the present way Americans deal with health care—itself a manifold topic
of many facets—is complicated, and changing even one aspect of the current
system is like pulling on one thread of a spiderweb—the whole thing is likely
to be affected.

Historically, sick people have been cared
for through a combination of love and money, Mother Teresa’s nuns representing
the love end of the spectrum and Big Pharma representing the money end.  When the main criterion of a potential
cure for a fatal disease is the question of how much money it will earn for
investors, we have gone too far toward the money end of the spectrum.  Medical care is a business, but it used
to be more than a business—it was a calling.  And unless those involved at all levels of health care
perceive the need for love as well as money, things won’t get any better in
that regard. 



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