Brown Bioethics Society blog

snatched from the Morning Mail

2006-04-19T11:27:00.000-04:00

What are you doing next Saturday? I hope I'll be in Petteruti.

From: "Anne Fausto-Sterling Ph.D"
To: All Students, All Faculty

Subject: Science in the Public Eye: An Exciting Symposium

Save the date!! April 29th 10 to 4, "Science in the Public Eye" Petteruti Lounge.

10 am: "Must the Media Always Inflame Public Controversies about Science?"

11:15 am: "Mining in the West: Who Pays for the Cleanup?"

1:30 pm: "Impertinent Questions and Bloody Fingers"

2:45 pm: "Teach Globally, Learn Locally: Telling Universal Stories about Particular Places"

Moderator: Catherine Imbriglio, Brown University

More info: http://www.brown.edu/Faculty/COSTS/events.html

Numbers of Child Psychiatrists Low

2006-04-07T11:54:00.000-04:00

CNN recently reported on what it calls a severe lack of child psychiatrists in America. The article, for which Dr. Gregory Fitz of Brown Medical School was interviewed, explains that every state suffers a shortage of child psychiatrists (based upon need projections by the U.S. Bureau of Health Professions). Wyoming, for example, has only two child psychiatrists.

The low numbers of child psychiatrists has been attributed to the training and work requirements associated with the field. For one, the training for child psychiatry is longer than that for general psychiatry. Furthermore, some practitioners lament the increased time needed to counsel both patients and their parents. Child psychiatrists are not compensated for the additional time associated with the field.

The decrease in the numbers of child psychiatrists raises interesting questions. Student bioethicists at Brown have, for some time, debated the practices of child psychiatrists (including the use of antidepressant medications in children). In a number of situations, students have concluded that psychiatry in general (and child psychiatry specifically) ought to reevaluate its practices. Therefore, it may appear almost positive that the numbers of child psychiatrists have decreased.

This viewpoing is probably both simplistic and dangerous. Indeed, the lack of child psychiatrists ought to be perceived as a problem even for those who question the behavior of some psychiatrists. For one, we should note the recognized importance of child psychiatrists in particular circumstances, including child abuse and trauma.

Furthermore, our recent dearth in child psychiatrists should raise general concerns regarding the number of juvenile and adolescent-specific clinicians in our country. If, for practitioners, juveline practice is more expensive than adult practice, and if training for juveline practice is more extensive than it is for adult practice, then we ought to consider providing incentives for studying juvenile practice. Might there be particular government incentives for entering into pediatric medicine to offset the added training and work associated with counseling both a patient and his or her family members?

What's more, this may be a fruitful time for individuals who protest the practices of child psychiatrists to propose alternatives to drug therapies for children. The lack in child psychiatrists means that many children receive no counseling, diagnosis, or treatment. If alternatives to drug practices are indeed beneficial for children (and if empirical support exists backing these claims), then we ought to see serious proposals for the inclusion of alternatives to drug therapy in insurance programs, government medical programs, etc.

Our current lack in child psychiatrists may be a dangerous thing, even if psychiatry suffers from its own lapses in standards of practice. It may signify a more general problem regarding pediatric care. During this dearth in the numbers of psychiatrists, it would be beneficial for both children and their families to have available at their disposal alternative treatment options. If these treatment options display standards of practice that are more empirically supported and objectively applied than are the standards of practice of pscyhiatry, then we will have transformed a period of deficiency into one of progress.

This is why Bioethics needs to stick around...

2006-03-15T09:32:00.000-05:00

These three headlines were all taken from CNN Internationl on one single day. These are the reasons that bioethics exists and needs to remain.

http://edition.cnn.com/2006/HEALTH/03/15/uk.clinical/index.html

http://edition.cnn.com/2006/LAW/03/15/court.baby.reut/index.html

http://edition.cnn.com/2006/LAW/03/14/body.parts.ap/index.html

While some of these stories are obviously far out of the ordinary and what seem to be out of a bad horror film, the ethical issues involved are blatant. Everyday we are confronted with new issues that seem "out of the ordinary" within biomedicine and ethics and it is for these issues that bioethics exists.

For an orphan drug, yet more buck for the bang

2006-03-13T15:25:00.000-05:00

Not to be outdone by Genentech, the small pharmaceutical company Ovation has upped the price of its orphan drug Mustargen nearly tenfold. The zinger? Mustargen's patent expired decades ago.

Mustargen, known generically as nitrogen mustard, is an old chemotherapy agent now used mainly as a topical therapy for cutaneous lymphoma. The appellation 'generic' is a bit of a misnomer, however: because of Mustargen's relatively small market (it grossed only $546,000 nationally in 2004), no other drug company finds it profitable to produce a generic competitor. Hence, Ovation can charge whatever it likes for the drug.

For those who sense predation in Ovation's change of heart, fear not. The increase in costs, according to a company executive, is necessary to invest in manufacturing facilities for the drug. (Ovation, in a stroke of entrepreneurial genius, recently acquired the rights to the drug from Merck, who, in the meantime, is providing the company with a steady supply.)

Yet again, price gouging is justified on the basis of phantom production costs. The hidden argument, of course, is one that is becoming more explicit day by day: drugs ought to be priced on the basis of their intrinsic value as life-sustaining therapies -- not on their research, development, or even marketing costs.

The argument is troubling. Its language implies universality; any reasonable person ought to realize the "intrinsic value" of drugs. (And there is arguably a price which everyone, or nearly everyone, might be willing to pay for the continued existence of life-sustaining therapies.) Unfortunately, "intrinsic value" here is determined based on price optimization in the marketplace, which is contrary to universal access. If consumers are desperate enough -- and in the special case of cancer patients, arguably they are -- price optimization may occur at a point where most consumers are priced out of the marketplace.

If drug companies were selling lemonade, that might be legitimate. But many of us, soft-hearted folk, treat life-sustaining health care as a special case: a social benefit to which even the poor and elderly are entitled. If not, wherefore Medicare and Medicaid?

This situation is also a reminder of the cozy regulatory situation drug companies find themselves in. Medicare, for example, is forbidden from taking into account a drug's price in determining coverage. While this protects healthcare consumers from the (fictional) possibility of cheap drugs being substituted for good ones, it also prevents Medicare from using its enormous purchasing power as leverage in favor of reduced prices. Until the inferiority myth about generics is debunked (see Marcia Angell's excellent book on the subject), Medicare will continue to operate with one regulatory hand tied behind its back.

As for Ovation, may they continue to, in their own words, "satisfy unmet medical needs." We're rooting for you.

The Academy's Obligation to Embrace Bioethics

2006-03-10T19:44:00.000-05:00

We are now in the wake of the recent Brown Bioethics Society's lecture by Sheldon Krimsky, where members of the Brown community confronted the sometimes dark, nonobjective nature of contemporary scientific practice as it exists in our academies. The problems introduced by the lecture welcome a storm of questions, the most significant of which may be, “Where do we go from here?” Members of the bioethics community at Brown have been grappling with this question for some time. Here, I provide my own take on scientific reform by briefly examining science’s sister field – medicine. (My argument here is written in anticipation of a forthcoming article that will appear in the Triple Helix's e-journal).

The 20th century brought with it a rapid modernization of the medical discipline. As physicians became more powerful and medicine became more of a presence in society, institutions of medical education embraced medical ethics curricula. This move came as society expressed its interest in training doctors who were not just smart, but good. Good, here, has a clear normative connotation. Nowadays, we have serious reason to question the legitimacy of any medical education program that omits medical ethics from its curriculum. We ought to question the values of such an institution.

However, it is important to note that the 20th century also brought with it a rapid modernization of scientific inquiry. This modernization has increased the presence of scientists in our society, and has (arguably) granted more power to scientists. As science became more advanced, it became less intuitively clear to the public and therefore had an increased chance of operating in isolation of the wants and needs of society. In this way, it gained power that it would not otherwise have had. (Inadequate science education may also be to blame for this inaccessibility). This modernization also inundated society with scientific advances and innovations, including scientific advances in medicine. In any situation where one institution has the ability to harm or benefit members of the public who themselves are not privy to the knowledge of that institution, we ought to ask ourselves, "How should members of this institution operate? What should they be permitted to do? What should they not be permitted to do?"

Just as the 20th century saw medical ethics' establishment as a discipline concerned with addressing these questions as they relate to medicine, bioethics has emerged to answer the same questions for the scientific community. However, even as society puzzles an increasingly more powerful, isolated scientific community, our research institutions and academies have not fully embraced the need for bioethics in their curricula. Although medical ethics is perceived as being necessary for physicians’ training, we do not actively promote a similar requirement for researchers. These two sister fields are thus held to very different standards of practice.

The idea that a research institution that trains thousands of undergraduate and graduate scientists, preparing them for professional research, lacks a program in bioethics ought to worry the public. If academies lack bioethics programs, then how can we be sure that the next generation of researchers is being taught “good science”? Are we to blindly trust the members of the scientific community? A growing body of evidence, including examples cited by Sheldon Krimsky, suggest that this sort of blind trust in academic science may not be safe.

The move to ensure that physicians have ethical training was an important one. We should now expand it to include all individuals who will conduct scientific research. Those scientific research institutions that have yet to establish undergraduate and graduate programs in bioethics ought to be compelled to do so by established advisory panels, public organizations, and representatives of the public (including governmental officials). The very small list of schools moving to dissolve their bioethics programs ought to be chastised for their disregard for public needs. Scientific research academies that neglect ethical inquiry as a component of scientific training ought to be granted the same prestige as are medical schools that neglect the ethical training of their physicians. Institutions of this type embrace an “old curriculum” befitting the days when medical paternalism was the unquestioned law of the land. Now is the time for out with the old and in with the new.

Engineers say...

2006-03-09T13:06:00.001-05:00

In a letter to the Brown Daily Herald, students from Brown's Biomedical Engineering Society claim that bioethics is "essential to a 21st century liberal education" and "might help us to serve the world better." Among their more outrageous insinuations is that the entire Brown student body -- not just bioethics geeks -- might benefit from the continuation of the program. Finally, given these so-called observations, they term Brown's decision to cut the program "irrational."

I couldn't disagree more.

big pharma does india

2006-03-05T22:09:00.000-05:00

What is the German pharmaceutical company Boehringer Ingelheim doing in the small town of Sevagram, India?

The answer is in this month's Wired magazine, which covered a (now familiar) story on the outsourcing of clinical drug trials. This particular story is about the stroke-prevention drug Aggrenox. Boehringer has set up 28 trial sites in India; they are offering participants 2 physicals per year for 3 years (the length of the trial) and 30,000 rupees (about $665) to participating hospitals. The drug has been described as having "possible side effects and limited efficacy."

But why India? Well, with a population hovering around the 1 billion mark, India offers a resource America is running out of: willing research subjects. What's more, many of the people signing up for the trials are poor, illiterate and "treatment" naive (which limits the possibility of adverse interactions between drugs). Where American doctors have become suspicious of big pharma and their tickets to Hawaii, many Indian doctors see participation in the trials as a great opportunity for them, their patients, and their hospitals. The benefits to both sides seem apparent.

Perhaps one of the most controversial elements of this story, however, is the issue of informed consent. The article focuses on the experiences of Dr. Kalantri, who describes his patients as passive recipients of their health care. Indian consumers are not "educated" about drugs or health issues like Americans. Medications are not household names in India, but foreign bodies with miraculous mechanisms. Similarly, doctors are revered in many parts of India. Kalantri writes,

"Nine out of 10 times, the patients will just ask me to make the decision for him. So what role do I play? Am I a physician, concentrating on what's best for the patient? Or am I a researcher interested in recruiting patients? I try to balance the two sides but...it's a dichotomy."

The doctor is clearly in a bind, asked to make difficult decisions on his patients' behalf, who don't even know the basic science required to make educated decisions.

Another issue is that the drugs being tested are irrelevant to the true health concerns of a country like India. As Kalantri explains, "finding better treatments for osteoporosis and high cholesterol is important...but these are diseases that will cause problems at 40 or 50. Infectious disease like malaria and filariasis kill at 20 and they're much more common here." Health care in India just isn't ready for large-scale preventative measures. Before they are ready to work towards creating a health country, they need to tackle diseases that we just don't see much of here.

Maybe it's my deep love for India or maybe it's my deep (cough) hate (cough) of drug companies, but something about this makes me very uncomfortable...

Wal-Mart bows to Plan B. Sort of

2006-03-05T16:50:00.000-05:00

In response to political pressure from state governments, Wal-Mart has announced plans to carry Plan B in its 3,700 pharmacies nationwide.

With a catch: under a conscience clause, pharmacists will retain the right to refer customers seeking Plan B to another pharmacist -- or, if they are the only available provider, to another pharmacy altogether.

Wal-Mart's press release claims the right of conscientious objection to be "consistent" with the tenets of the American Pharmaceutical Association. And it is. In testimony before the House in 2005, association member Linda MacLean clarified APhA's policy:

APhA's policy supports the ability of a pharmacist to opt out of dispensing a prescription or providing a service for personal reasons and also supports the establishment of systems so that the patient's access to appropriate health care is not disrupted [...] [O]ur policy supports a pharmacist 'stepping away' from participating but not 'stepping in the way' of the patient accessing the therapy.

The distinction between "stepping away" and "stepping in the way" is well and good for those of us who live near pharmacies not named Wal-Mart (or Sam's Club). But what about towns where Wal-Mart is the only pharmacy around (given that they've driven local pharmacies out of business)? Towns where the moral climate brings public hostility to bear on pharmacists? The options for poor, young, or uneducated women -- arguably, those most likely to seek emergency contraception -- start to look exceedingly slim.

Wal-Mart's change of heart is a fan-friendly one. Just not to those who need it most.

supplementary material

2006-03-03T13:17:00.000-05:00

We're not dead yet and neither is our press coverage. Check out today's Editorial Cartoon in the Brown Daily Herald.

Last words on Brown bioethics

2006-02-28T12:18:00.000-05:00

As the undergraduate bioethics program at Brown lurches towards oblivion, it's nice to know that we're at least getting some free press over it.

The Brown Daily Herald has published a news article on the demise of the concentration. And if you thought that wasn't enough, they've also managed to print an opinion piece (read: partisan propaganda) written by a few of us challenging the university's apathy towards bioethics.

For more reading, check out last year's entry in the AJOB editors' blog bidding farewell to Brown bioethics.

HHS to NIH: Limited Funding for Participation in International AIDS Conference

2006-02-27T19:43:00.000-05:00

The NIH had hoped to send 77 of its staffers to the upcoming International AIDS Conference to be held in Toronto. However, if the Department of Health and Human Services has its way, only 25 will be permitted to attend. The Bush Administration is again endorsing limits on the number of federal employees that may attend international conferences. (While these limits were defined by Congress, they have been waved in the past).

If we accept that the open exchange of scientific hypotheses, theories, and findings is integral for progress, and if we agree that the global AIDS pandemic is a topic of scientific inquiry for which progress ought to be made, then this policy does more harm than good. In an age when science is becoming more industry-driven (and therefore less publicly accessible and less objective), we ought to be concerned with strengthening our government-endorsed research programs. Limiting the NIH to one third of the positions it requires will simply hinder opportunities for progress for US and foreign researchers. Is placing a quota on idea exchange really the best way to save money?

The only way around the policy seems to be a move to hold an international AIDS conference on domestic soil. However, this has not been done since 1990 due to a 1993 immigration and naturalization policy that severely restricts the ability for individuals living with HIV to legally enter the US.

The international community has boycotted the US in opposition to this policy, opposing it on ideological and practical grounds. On one hand, the policy clearly discriminates against individuals based upon their health status (with no rational justification for this discrimination). On the other hand, it places a technical hurdle in the way of AIDS conferences, where participants are sometimes HIV positive.

United States policy has therefore boxed us into a corner: we restrict the entry of individuals living with HIV onto our soil, effectively precluding the possibility of a US hosted International AIDS Conference. At the same time, we tell the NIH that they must slash their list of conference attendees to 1/3 their intended amount, simply because the conference is held on foreign soil.

Nowadays, Canada really does seem to be a world away.

Flu Wiki

2006-02-27T04:50:00.000-05:00

To read about pandemic flu preparedness, you might check the websites of the CDC, WHO, even the Department of Health & Human Services. But a wiki?

Flu Wiki, to be exact -- the self-described "most complete" internet source on pandemic flu.

Its anonymous contributors, according to the site's creator, include some of the U.S.'s foremost experts on pandemic flu. But why the anonymity? Because they fear reprisals from the Bush Administration for contradicting avowed policy.

With "massive" bird flu looming in China, it's likely a matter of time before A5N1 hits domestic shores. So it's particularly troubling that government-funded scientists are being pressured, explicitly or not, into keeping their mouths shut on flu policy.

If and when the pandemic hits, only an informed public that trusts its government will be equipped to handle the consequences. And for that, we'll need inoculation of a different kind -- a dose of transparency from the Bush Administration.

Sheldon Krimsky @ Brown

2006-02-25T17:06:00.000-05:00

Thanks to everyone who made Professor Sheldon Krimsky's lecture here at Brown a success.
(You know who you are.)

Here's a link to the Brown Daily Herald's coverage of the event.

Plan B fallout at the CMAJ

2006-02-22T14:19:00.000-05:00

The Canadian Medical Association has dismissed the top two editors of the Canadian Medical Association Journal over a dispute concerning the journal's coverage of privacy violations Canadian women experienced when obtaining Plan B.

The article, which was published late last year, reported that Canadian women seeking Plan B at pharmacies across Canada were routinely asked for personal information, sometimes including sexual history, before being given the over-the-counter pill. This information was entered into computer databases.

The publishers of the journal, CMA Media, headed by Graham Morris, demanded that substantial portions of the article be cut -- including the description of the experiences of the women. Its rationale? That the account of the women's experiences did not constitute reporting but that it amounted to scientific research and hence required peer review prior to publication.

Of course, there's no reason to believe that any of this has to do with information reporting standards and peer review. Rather, CMA's action is a blatant instance of top-down political bias compromising the editorial independence -- and hence, the integrity -- of the CMAJ.

When heads start rolling at Canada's self-described leading medical journal over semantics, you can bet it's political.

Global warming: fact or (best-selling) fiction?

2006-02-19T14:45:00.000-05:00

Michael Crichton, author of State of Fear, a best-selling work of fiction challenging the existence of global warning, has won a journalism award from the American Association of Petroleum Geologists.

In a review posted on the AAPG's web site, State of Fear is termed a "wake-up call" for geologists who have fallen prey to environmentalists' "perverted science." Crichton's scientific analysis is given credence on two accounts: first, because "much of what passes for science is actually fiction"; second, because he has "real scientific credentials": namely, an undergraduate anthropology degree and an M.D. from Harvard.

While intersubjective criticism is vital for ensuring scientific objectivity, Crichton is no geologist or climatologist. He is a fiction writer. Furthermore, it is fatuous to impugn the objectivity of science in order to justify putting science fiction and scientific practice on equal epistemological footing.

Stanford climatologist Stephen Schneider, on the other hand, terms the book "demonstrably garbage." It appeals to petroleum geologists, he says, only because "they are ideologically connected to their product."

Crichton's politically savvy pseudoscience hasn't escaped willing ears: namely, those of President Bush, who invited the novelist to the White House last year for an hourlong chat which left both men in "near-total agreement" about global warming.

Crichton has also testified before the Senate challenging the methodological rigor of climate science. In his testimony, he attests that it is "the proper function of government to set standards for the integrity of information it uses to make policy."

Guess the AAPG didn't get that memo.

Healthcare Concerns for LGB United States Military Personnel

2006-02-18T16:09:00.000-05:00

A recent article in Professional Psychology: Research and Practice discusses the difficulties faced by military psychologists serving lesbian, gay and bisexual (LGB) military personnel. It provides a very interesting discussion of medical practice in circumstances where standards of medical ethics conflict with institutional requirements (e.g. military rules).

Official military rules allow for confidentiality (within certain limits) for military psychologists. However, these rules lack teeth in a military system that values military oversight of service-members’ lives. For example, military psychologists’ records may be viewed by non-medical staff members of the military, particularly when staff members suspect that an individual’s performance may be linked to a psychological state. Thus, although psychologists needn’t openly disclose information, the military has devised a mechanism of bypassing the psychologist altogether.

As a result, some scholars advise psychologists to avoid documenting references to homosexual activities during therapy sessions. This recommendation, if followed, may lead to records being left dangerously incomplete. If a service member’s suicidal tendencies are linked to homosexual feelings, a medical record that omits references to the patient’s homosexual feelings may harm a patient more than help him. If the service member changes psychologists, for example, the new psychologist may be left unaware of the causes of the patient’s suicidal tendencies. As a result, the quality of therapy may be decreased. When choosing how to document a patient's condition, a psychologist may be forced choose between the lesser of two evils.

Furthermore, the regular rotation of individuals through military posts means that a service-member who is a psychologist today may be asked to abruptly change positions tomorrow. It is unclear how a military psychologist who counsels an openly gay service-member will handle information of the member’s homosexuality when he becomes a military administrator who is charged with imposing “Don’t Ask; Don’t tell.” Should he simply pretend that he was not told?

We have no reason to believe that only academics ponder these questions. Service members considering whether to seek counseling for feelings of depression or anger associated with their sexuality may be hesitant to trust psychologists enmeshed in the military machine. As a result, these individuals may turn to the only “counselors” in military settings for whom confidentiality is guaranteed: chaplains. Chaplains are often individuals who lack medical training and who have been known, in the past, to suggest “reparative treatment” for homosexuality. Needless to say, reparative remedies lack scientific support just as chaplains lack the medical credentials needed to counsel individuals coping with homosexual feelings.

Our first priority ought to be repairing a military environment that exacerbates the already difficult task of coping with homosexual feelings. The very fact that service-members avoid counseling for fear of being removed from the military is startling to say the least. However, changes in the ‘Don’t Ask; Don’t Tell” policy must await a more rational period in American politics. In the meantime, the military ought to seriously consider importing civilian psychologists onto military bases and making these experts available for service-members. These civilians ought to be guaranteed uncompromised client-patient confidentiality.

Questionable University Funding Criteria for Genetically Modified Food Research

2006-02-18T02:20:00.000-05:00

I recommend Andrew Pollack's recent New York Times article for those looking for a concise explanation of the considerable hurdles precluding research in genetically engineered foods.

Interestingly, it appears that university research into genetically engineered crops (e.g. tomatoes rich in lycopene, a caretenoid believed to have cancer-fighting properties) is facing a lack of funding. This development is significant, as genetically engineered foods are hailed by many members of the scientific community as a potential solution to the developing world’s disease burden. Some suggest that university funding cuts are fueled largely by the fact that genetically modified foods are not often brought to market due to the social stigmas attached to the crops.

We ought to be worried if, indeed, it is true that market predictions and social stigmas are dictating university research funding. If market predictions are influencing the decisions of funding committees, then this represents yet another instance of economic interests moving science away from the objective principles we expect of a public institution. Decisions influenced by social stigmas, conversely, may appear acceptable, as they involve consideration of public interests (after all, science ought to be a public institution). However, it is dangerous to allow for public fears regarding the potential harms of genetically engineered foods to preclude objective scientific research aimed at producing safe crops. To do so would be to allow for the current shortcomings of our technologies to preclude any efforts at improving these technologies.

Universities should continue to fund research into new methods of engineering safe and effective foods, with the understanding that the end result of research may not be perfect. However, the information gained through such research may be useful for the future production of safe, effective foods. Assuming that genetic engineering research itself can be conducted in a safe manner (and there is little reason to suggest that safe, contained experiments cannot be conducted), the research ought to be pursued.

The University serves as one of the final arenas for the pursuit of truly public science. In the case of genetically engineered food research, this is precisely the brand of science we need most. Indeed, we may find that university research will serve as the main avenue through which social stigmas regarding genetically engineered foods are refuted.

New Rotavirus Vaccine an Expensive Ethical Fix

2006-02-16T01:19:00.000-05:00

Recently, Merck secured FDA approval for its new rotavirus vaccine, Rotateq. The new vaccine has been viewed as an alternative to Rotashield, Wyeth's ill-fated rotavirus vaccine that was found to lead to an increased rate of intussusception, a potentially fatal intestinal complication.

In 1999, Rotashield was pulled from the US market. However, continued vaccine studies were considered in the developing world, where pediatric rotavirus mortality rates are greater than morality rates from Rotashield-induced intussusception. Many argued that support for these studies would presuppose that lower standards for pediatric vaccine safety in the developing world were ethically permissible. In the end, developing countries refused to use a vaccine that had been deemed too dangerous for US children.

Now, eight years after Wyeth's development of Rotashield, Merck has developed Rotateq, a vaccine that solves the intussusception problem. For some, this new vaccine marks the end of a bitter debate regarding the use of Rotashield in the developing world.

However, this shiny solution comes with a shiny price tag. Merck will charge $187.50 for the three required doses of Rotateq, making Rotateq one of the most expensive vaccines on the market. Merck predicts that, by 2009, the vaccine will bring in as much as $500 million in annual revenue. Rotashield, meanwhile, had a significantly cheaper $114 price tag.

It is good to know that Merck’s $500 million dollar profit will come largely from the developed world, where rotavirus is more of a nuisance than a killer. Indeed, the vast majority of rotavirus deaths– 82% of them – occur in the poorest countries.

Rotateq’s price tag brings it far out of reach of the countries that most desperately need a rotavirus vaccine. Thus, although we may have succeeded in developing a rotavirus vaccine that addresses an important side-effect issue, we have not succeeded in producing a vaccine for the developing world. For the poorest nations, where rotavirus mortality is the highest, the choice may still be between a cheaper, more dangerous vaccine or no vaccine at all.

Genentech's 800 lb. gorilla

2006-02-15T15:46:00.000-05:00

Genentech is planning to charge double for Avastin's use in breast and lung cancer.

Avastin is already approved as a last-ditch colon cancer therapy (for which Genentech charges $50,000 for a year's supply). So why the additional cost? Doctors must use double the dose of Avastin for breast and lung cancer. At least, that's the only dose that was used in the clinical trials for breast and lung cancer, leaving doctors in the dark about the efficacy of the lower dose.

Genentech plans to stick by its price-per-milligram scheme, despite the fact that the additional cost of production is minimal. (If Avastin's new price holds, the drug's yearly revenue will rise from $1.1 billion to approximately $7 billion by 2009.)

Because they can't claim they're recouping R&D expenses, Genentech is using a novel justification: the inherent (read: market) value of life-sustaining therapies. A member of Genentech's board, William Burns, sums it up quite nicely: "As we look at Avastin and Herceptin pricing, right now the health economics hold up, and therefore I don't see any reason to be touching them. The pressure on society to use strong and good products is there."

It's interesting how overt the commodification of health has become in the discourse of drug company execs. It's one thing to charge an arm and a leg for "lifestyle" drugs like Viagra, but quite another to let desperate competition between cancer sufferers optimize your asking price.

Go... Genentech!

Clay Pots and Evolution

2006-02-14T03:24:00.000-05:00

While checking my e-mail, I ran across a Google-targeted ad for an article pitting evolution against common sense. Lo and behold, I found the "mousetrap" argument from irreducible complexity refashioned, using religious discourse, into an appealing argument about clay pots. (For the old-school fans of intelligent design, there's an allusion to Paley's Watch in there too -- David Hume be damned.)

While the philosophical rigor of this Christian fundamentalist website isn't impressive (for other interesting reading, see "Did God Make Me Gay?" and "God is an Elephant?"), it's worth noting that irreducible mousetraps, apparently, come in many forms.

That which we call a rose...

Birth

2006-02-13T21:28:00.000-05:00

Greetings all,

Welcome to the Bioethics Society blog. Here's hoping we can use it to share bioethics-related articles, post original commentary on bioethics issues, and keep track of bioethics lectures and events across campus (there are so many of them). Who's with me?

Happy posting,
FF