health care — VOICES for REASON

Last month, the FDA began withdrawing approval of Avastin for treating breast cancer. Over at Pajamas Media, I explained why that violates the rights of sick patients. Now USA Today is attempting to quell the “Outcry over FDA withdrawal of anti-cancer drug Avastin” by painting the drug’s advocates as emotionalist, unscientific crybabies. Here’s the article’s approach in a nutshell:

“The emotional appeal is so compelling,” Fran Visco, president of the non-profit National Breast Cancer Coalition, says of breast cancer patients doing well on Avastin. But, Visco says, “drug approval cannot be based on any individual story. It has to be based on the highest level of science.”

Let’s stop and think about this for a minute. Ms. Visco refers to “breast cancer patients doing well on Avastin.” In other words, she’s talking about actual, living women with a dreadful, fatal disease, who are actually benefiting from the drug. What is Ms. Visco’s attitude toward them? Well, she’s willing to concede emotional sympathy with their anger at losing access to Avastin.

But according to Ms. Vasco, these individual women need to put aside their petty, individual concerns in deference to the demands of science. As she puts it, any given woman’s “individual story” has nothing to do with FDA regulators’ quest to reach “the highest level of science.” What is that “highest level of science”? It consists of statistical studies on large aggregates of patients, studies that deliberately ignore the individual patient in favor of averages.

In my article, I talk about the FDA’s idea that Avastin does not “represent a favorable risk/benefit analysis”:

Does that mean the drug fails to help any woman more than it hurts her? Not at all—many individual women benefit from the drug. But the FDA regards such facts as sentimental distractions, to be deliberately ignored when deciding the fate of a drug like Avastin. The FDA’s idea of a risk/benefit analysis deals with health in the aggregate, as revealed in statistics involving large populations, not with the health of individuals.

But can risks and benefits really be weighed at the level of society as a whole? A society is only a collection of individuals. A society doesn’t enjoy life, or suffer—only individuals do. Metaphors aside, a society doesn’t get sick and die—only individuals do. To appreciate the difference, consider how a rational patient with breast cancer decides whether to undergo drug treatment.

Such a patient weighs (among other things) the statistical likelihood of a favorable result against the statistical likelihood of painful side effects. At all times, her judgment is individual and personal: How will my life improve if these tumors temporarily stop growing? How might side-effects interfere with my enjoyment of life? How much better will I feel if the results are above average—or how much worse, if the results are below average? How much is an additional year, month, or week of relatively normal life worth to me?

The FDA’s experts take professional pride in refusing to allow such individual considerations to influence their decisions. Instead, they float among the statistical clouds, observing that Avastin delays tumor growth by only 3 to 12 weeks on average and that some patients actually get worse after taking the drug. From behind a veneer of scientific respectability supplied by charts and graphs that ignore the individual patient, these experts then ask a question to which no rational answer can be given: What is the meaning to society of one month in an individual’s life?

The bottom line is that statistical studies are useful tools for individual risk analysis—but when the FDA coercively substitutes that collective data for the individual’s rightful choice, the agency turns that science against those who should benefit from it.

Image: Wikimedia Commons

With a new year approaching, we looked back at some of the topics we discussed on VFR since the blog was launched. Here, we highlight a few of our favorite VFR posts that you may enjoy revisiting (or reading for the first time, if you’re a new reader).

Posts by Don Watkins.

• The rich get richer, the poor get richer, the New York Times gets outraged
• Controls breed controls: Part 1 | Part 2 | Part 3.
• The Unselfish Bernie Madoff
• The irrational argument for rationing health-care

Image: Wikimedia Commons

Early news reports indicate that the Food and Drug Administration is withdrawing its approval for the use of Avastin to combat advanced breast cancer. This, as I argue in my Pajamas Media article on the controversy, is a travesty. Here’s a video version of that article:

In our latest Forbes.com piece, ARC’s Yaron Brook and I examine the ObamaCare individual mandate:

A federal district judge has struck down ObamaCare’s individual mandate as unconstitutional in a case expected to go to the Supreme Court. Judge Hudson is to be commended on his decision, for not only is the mandate unconstitutional, it is also immoral.

You can read the whole thing here.

By the way, Forbes.com has a new format for our column. To follow our latest, just bookmark http://blogs.forbes.com/objectivist/.

Over the weekend, Pajamas Media published my op-ed “The Avastin Travesty.” The timing is good, because the federal Food and Drug Administration is scheduled to vote this week on withdrawing approval of the cancer-fighting drug Avastin, for treatment of breast cancer.

Here’s some of what I said (click here for the full article, which includes an active comment section):

The FDA is slated to decide whether to follow the advice of its own Oncologic Drugs Advisory Committee, which back in July voted 12-1 that Avastin does not “represent a favorable risk/benefit analysis.” Does that mean the drug fails to help any woman more than it hurts her? Not at all — many individual women benefit from the drug. But the FDA regards such facts as sentimental distractions, to be deliberately ignored when deciding the fate of a drug like Avastin. The FDA’s idea of a risk/benefit analysis deals with health in the aggregate, as revealed in statistics involving large populations, not with the health of individuals.

But can risks and benefits really be weighed at the level of society as a whole? A society is only a collection of individuals. A society doesn’t enjoy life, or suffer — only individuals do. Metaphors aside, a society doesn’t get sick and die — only individuals do. To appreciate the difference, consider how a rational patient with breast cancer decides whether to undergo drug treatment.

Such a patient weighs (among other things) the statistical likelihood of a favorable result against the statistical likelihood of painful side effects. At all times, her judgment is individual and personal: How will my life improve if these tumors temporarily stop growing? How might side-effects interfere with my enjoyment of life? How much better will I feel if the results are above average — or how much worse, if the results are below average? How much is an additional year, month, or week of relatively normal life worth to me?

The FDA’s experts take professional pride in refusing to allow such individual considerations to influence their decisions. Instead, they float among the statistical clouds, observing that Avastin delays tumor growth by only 3 to 12 weeks on average and that some patients actually get worse after taking the drug. From behind a veneer of scientific respectability supplied by charts and graphs that ignore the individual patient, these experts then ask a question to which no rational answer can be given: What is the meaning to society of one month in an individual’s life?

When choosing what medicines to take, each individual patient is entitled to regard his or her own life as the most precious thing in the world.  But the FDA regularly outlaws that kind of individualistic decision-making. Tell me again why we tolerate the FDA?

[Update: Thanks to Andrew Breitbart's BigGovernment.com for linking to my Pajamas Media article.]

Image: Wikimedia Commons

It seems like only yesterday when cries of “Repeal Obamacare!” were sending thrills (or chills, depending on your point of view) up the spines of American voters. But now, according to this article from NPR, that chant has morphed into “repeal and replace”—and who do we find in the vanguard but American businesses.

Here are a few paragraphs from the NPR article, with my comments interspersed:

“No one has said what this bill would be replaced with,” said Richard Umbdenstock, president and CEO of the American Hospital Association. “But doing away with this would certainly be the wrong thing. … People have been gearing up for some time, well before this actual bill got passed, to make these changes locally, and have invested a lot.”

It’s not just hospitals. Employers, particularly large employers, have already put considerable time, effort and money into implementing the parts of the law that have already taken effect. And just the possibility that the law will be repealed or substantially changed could present a serious problem.

“It takes a long lead time to execute any policy, so at this point having a lot of uncertainty and policy volatility really works against helping us to move toward solving the problems of the country,” said Helen Darling, president of the National Business Group on Health, which represents many of the Fortune 100 corporations.

There are many things worth noting here, but what I find especially fascinating is the utter absence of any concern with freedom. There is simply no concept that repealing Obamacare might (partially) liberate hospitals, insurance companies, doctors, patients, and businesses to deal with health care issues according to their own best judgment. Rather, the sole concern is with minimizing the costs of “executing policy.” Whose policy? The government’s.

Of course, I make allowances for the fact that this article focuses on lobbyists, not business owners or managers whose private opinions might differ (and whose opinions one would not necessarily expect the left-leaning NPR to publicize). I also concede that businesses have a legitimate interest in minimizing the expense of keeping up with volatile government programs. Yet we must keep in mind that the passage of Obamacare was not some minor re-jiggling of regulations hashed out behind closed doors—it was a milestone event that excited widespread national debate over the limits of government power. That’s a context in which even companies that are normally afraid to peek out of their foxholes might think about taking a stand in their own defense. Yet the NPR article continues:

Plus, says Darling, with the number of uninsured Americans at 50 million and growing, “starting over would make it virtually impossible to make real progress anytime soon.”

Here, it’s taken for granted that complex government policies will control everyone’s action in the realm of health care. What Ms. Darling counts as “progress” therefore consists of settling on one set of policies, so that her Fortune 100 clients can accommodate themselves to the government’s will. It’s not clear how typical are the opinions reflected in this article, but I haven’t heard about significant groups expressing opposite views.

That’s not to say that the health care industry loves the law. No segment of the industry got everything it wanted, and everyone is busy lobbying for something to be changed.

“There are plenty of opportunities for improvement, fine-tuning and actually adding some significant enhancements, especially in controlling costs,” Darling says.

Observe that doctors, hospitals, health insurers, and businesses that pay for health care all seem to accept the status of pressure groups, pleading for favors. Who’s the dispenser of those favors? The government.

The health insurance industry, in fact, wants to make more than just fine-tuning changes. It’s been among the most outspoken critics of the measure. But even insurers haven’t come out in favor of scrapping the whole law and starting over—particularly not when it stands to get millions of new customers.

Millions of new customers? Oh, yes—that’s what the industry expects from Obamacare’s mandate that every individual buy health insurance. And when you think about it, that’s entirely consistent with the health care industry’s status as a pressure group. After all, isn’t a pressure group’s success often measured by the number of dollars that can be sucked out of other people’s pockets?

In all this, there’s no mention that any of the individuals or businesses involved have rights—meaning moral entitlements to freedom from coercive interference while doing business. But in my view, Obamacare is a massive assault on individual rights that should be obliterated, as a first step toward achieving a free market in health care. I don’t expect that to happen anytime soon, but I’m disappointed that nobody (including Obamacare’s worst victims) even seems to find it worth talking about.

Image: Wikimedia Commons

At a time when hostility against the oil industry is at a high, while politicians and editorial-office heroes call for “ending our addiction to oil,” it’s important to reflect on why oil is so valuable—so “addictive,” in the terminology of our time.

A couple months ago, I blogged that “Most of us think of oil simply as the stuff that puts gasoline in our car. But oil, thanks to the ingenuity of the oil industry, does so much more. For one, it’s the building block for thousands of petroleum products—everything from Blu-Ray discs to asphalt to stitches to lipstick. And it provides the safest, most powerful, most convenient fuel, not only for automobiles but for the freighters, jets, trucks, and industrial machinery that power our global economy. Oil makes every aspect of our lives better.”

In that post, I illustrated how oil was vital in making possible something as basic as an affordable, healthy breakfast. The other day, I witnessed firsthand how vital oil is in making possible a safe, effective hospital. Sitting in on a highly advanced surgical procedure, I was struck by the skill of the surgeons, the stunning advances in medical technology (almost all of which involve petroleum components), and—what I want to talk about today—everyone’s commitment to maximize safety by keeping the environment as hygienic as possible by using oil-based products at every turn.

One of the virtues of petroleum products, including plastics, is that they are incredibly resistant to bacteria, moisture, germs. Another is that they can very easily be made impermeable, protecting whatever you want from whatever you don’t want to contaminate it. They can also be made incredibly cheaply, which allows for disposable products that are never used by more than one patient.

All of this was at work in the operating room. Just about all the furniture—the chairs, the cabinets, the drawers, were made of or coated by petroleum to keep them sanitary. The patient was lying on the bed, connected to durable, flexible plastic (oil) tubes that safely delivered food, coming from a sealed plastic (oil) bag that securely stored it. Another oil tube was designed to vacuum excess fluids. There were disposable foam (oil) cradles to prop up the patient’s arms or legs if necessary—made of oil to be disposable. The disposable, sterile gloves were either latex or synthetic—i.e., made of oil. Ditto for the disposable surgical masks and head-coverings. The doctors frequently needed to throw biological material away—which, thankfully they could do sanitarily with plastic (oil) trash-bags that could be taken away leaving no trace of their hazardous contents. Imagine if these products would have been made of wood, cloth, or metal. Can you imagine the corrosion, the bacteria-traps, the health risks? Infection used to be a highly common and deadly product of surgery—and lack of petroleum products was a big reason why.

Thanks both to the medical profession and petroleum products, you can have every expectation of your next trip to the hospital being a safe one.

Source: Wikimedia Commons

ObamaCare included a little-noticed provision that will force restaurant chains with twenty or more stores to list how many calories are in each menu item. My view: The government has no business getting involved here. If we want to know how many calories are in our lunch, we can patronize only restaurants that tell us.

But you might wonder: Who could possibly object to giving people more information?

Well, here’s one man who does. Ken Schelper is a Vice President of Davanni’s, a small chain of pizzerias. He notes that under ObamaCare’s caloric mandate, his company will have to pay tens of thousands of dollars to replace all of its store menus, brochures, and drive through signs–every time it changes a single ingredient.

Information isn’t costless. Whether it involves scientific experiments to discover how many calories are in a slice of cheese or printing new menus, providing customers with information imposes genuine costs on businesses–costs that ultimately get passed on to consumers in the form of higher prices and fewer options.

Supporters of the menu requirement would have us believe that the only reason a company would choose not to provide certain kinds of information is because it’s trying to put something over on us. That’s simply not true. It’s worth noting, in this regard, that before ObamaCare passed, customers of Davanni’s were able to find out the caloric content of their food. It was on the restaurant’s website.

Image: flickr

“Brutal blackmail” and “a violation of corporate social responsibility.” That’s how some diabetics in Greece are describing the recent decision by Novo Nordisk, a Danish pharmaceutical company, to stop selling certain insulin products in Greece.

Novo Nordisk manufactures easy-to-use insulin delivery devices that resemble fountain pens. More than 50,000 Greek diabetics use them. But not for long. The company has withdrawn the products from the market.

Why? Because the government of Greece is trying to mitigate its financial crisis at pharmaceutical companies’ expense by unilaterally ordering a 25% reduction in the price of all medicines. According to a Novo Nordisk spokesperson, “the price cut would force its business in Greece to run at a loss.” Oh yes, there’s also a little matter of $36 million that Greece already owes the company, with no certainty of payment in sight.

By any rational standard of justice, Novo Nordisk is completely in the right here. The company has done nothing to harm Greeks—on the contrary, it has offered them a positive value they didn’t have before, benefiting tens of thousands of people. By refusing to sell its products at a loss, the company is simply leaving Greek diabetics exactly as they were before it first offered those easy-to-use insulin pens for sale. Greeks who want more such devices should figure out a way to pay for them—not expect Novo Nordisk to sacrifice for the resolution of financial problems created not by them but by the Greeks themselves. Read the rest of this entry »

Throughout the health care debate, we have been arguing that the push for government control of health care is driven by a certain moral view: the view that need is a claim. That view is typically taken to be noble and benevolent, and one of Ayn Rand’s most controversial conclusions is that it is in fact vicious and unjust. Well, the latest proposal out of Massachusetts seems designed to prove Rand’s point.

Massachusetts, you probably know, passed a bill very similar to ObamaCare a few years back. Well, shocking news: the state is now hemorrhaging money. To stop the bleeding, it is clamping down on doctor reimbursements for Medicare and Medicaid, which has meant fewer and fewer doctors willing to accept Medicare/Medicaid patients. The state’s solution? Force them.

Every health care provider licensed in the commonwealth which provides covered services to a person covered under “Affordable Health Plans” must provide such service to any such person, as a condition of their licensure, and must accept payment at the lowest of the statutory reimbursement rate…

As one doctor noted: Read the rest of this entry »