blog.bioethics.net

Weekend reading

NYT: A Drug Maker's Views of What Ails Health Care
Via Art Caplan comes this interview with the chief executive of Novartis:

Q. Is the pharmaceutical industry part of the cure or part of the problem?

A. If you look at the mortality rates from hypertensive heart disease or stroke or gastrointestinal bleeding or cancer, in the past 40 years, these diseases have declined as the cause of mortality by 60 to 70 percent. Medicine has made huge progress and to a large part it’s due to better pharmaceuticals.

Having said that, the prices have increased significantly. People are starting to ask, “Is it too expensive?” There are, of course, internal costs which one has to take into account. We have invested 17 percent more, year after year, in the past six years for research and development. Externally, clinical studies have become longer and more difficult. And regulatory authorities, especially the F.D.A., have become extremely risk-averse, increasing the risks of research dramatically. That is all contributing to the cost of pharmaceuticals.

WP: Va. Studies Directives Giving the Mentally Ill A Say in Their Care
WaPo estimates that about 24 states have laws allowing people with mental illness to set up psychiatric advance directives:

"It's something that has made life much, much more manageable, where I don't have to be so afraid anymore," said Anders, who said she first had bipolar disorder diagnosed 30 years ago. "It helps me trust that I'm going to get the right care when I need it."

Some mental health experts, however, question the power and practicality of the documents, as well as their necessity.

In several states, clauses allow people with such illnesses to revoke their directives, even in the midst of a psychotic episode. Officials in those states often give the power of revocability to patients because they say ignoring the protestations -- even in situations where refusal of some medications is frequent -- could amount to coercive treatment.

"An irrevocability clause really equates to forced medication unless the person is sitting passively and accepts the medication," said Robert Fleischner, a staff attorney at the Center for Public Representation, a disability law firm in Northampton, Mass., that has done work on the documents.

Economist: Humane league
Genetic engineering could lead to fewer and more humane experiments on animals -- maybe:

[A researcher at China's National Institute for the Control of Pharmaceutical and Biological Products] is fitting mice with the human receptor for the polio virus. Mice modified in this way are more sensitive to the virus than their unmodified cousins, so subtle changes in batches of vaccine can be identified. Such tests are cheaper than those which use monkeys. They are also quicker. It takes two months of monkey-watching to be sure that a batch is safe. A mouse will tell you in two weeks.

Yet replacing monkeys with mice does not cut the number of animals used. Indeed, since researchers started employing genetically altered animals this way, that number has been creeping back up. It is worth questioning how many of the tests now conducted are necessary.

-Greg Dahlmann