From: terry@thisbe.npd.Novell.COM (Terry Lambert)
Newsgroups: sci.med
Subject: Re: FDA still at large
Date: 29 Jul 92 17:29:42 GMT
Organization: Novell NPD -- Sandy, UT

In article <15889@pitt.UUCP>, geb@dsl.pitt.edu (gordon e. banks) writes:
|> In article <h2mm4m_.sss@netcom.com> sss@netcom.com (Small Systems Solutions) writes:
|> >In article <15854@pitt.UUCP> 
|> >	geb@dsl.pitt.edu (gordon e. banks) writes:
|> >
|> >>I suppose it was homeopaths and chiropractors that discovered the
|> >>benefits of a low fat diet in heart disease?  But what do you do
|> >>with people who have clogged arteries already and are about to
|> >>die from them?  Too late for them to try the low fat diet.
|> >>Just let them croak?
|> >
|> >Maybe...compare the cost of the bypass, and all comcomitant therapies, with
|> >granting basic health care to 100 people.  Bypass surgery will improve
|> >quality of life for some individuals (surgeons, in particular), but it
|> >is very expensive (even at the tenfold reduction in cost over the last
|> >ten years).
|> 
|> "OK, Mr. Jones, we've decided that instead of giving you your bypass,
|> we'll just confiscate your $20,000 and use it to provide basic health care
|> to 100 homeless people.  You won't be needing the money anyway
|> where you're going."  Do you see the problem with this?

	Yes.  The same problem with any "equal level of health care for all"
plan... what's in it for Mr. Jones to commit $20,000 to health care.  There
is no reward for his effort.  The argument about "greatest good for the greatest
number" doesn't apply in socialized medicine.  The way at least one proponent
of socialized medicine put it, "from each according to his ability, to each
according to his need" would entitle Mr. Smith to one of Mr. Jonses kidneys,
whether or not consent was given.  Why should Mr. Smith, who spent his $200 on
a new TV instead of health care, get $200 of Mr. Joneses bypass money?  100
people like Mr. Smith, and we are trading Mr. Joneses life for the ability of
100 people to watch "Cheers" on slightly larger television sets.

	The vast majority of "common practice" treatments in use today were once
high-cost, high-risk procedures.  It is only the amortization of developement
costs of large populations at moderate expense, or small populations at great
expense, that have made them practical.  Polio vaccine falls into the first
category, insulin and prescription lenses, the second.  Is there any doubt in
anyones mind that insulin would not have come into wide use, had not a small
number of people been willing to pay large amounts to stay alive?  Now care for
diabetes is nearly a "right" under Medicare.  Certainly, Genentech would not
have invested in the technology necessary to make the product "Humalin", an
engineered form of human insulin, had there not been a "captive market" that
was paying a higher price for an inferior alternative.

	I have diabetic friends who have to "pay to live"; I (and about 1/4
of the adult population of the US) have to "pay to see".  You don't have the
right to set a "cost effectiveness" limit on what that is worth to us, nor
will we grant it to you.

	I can not agree with the idea that "expensive" treatments should not
be used.  Their use encourages both improvement in the procedures (lowering cost)
and developement of alternative procedures to accomplish the same goals (also
lowering cost).  When the cost reaches common use levels, the treatments become
commonly used.  The United States is a leader in biotechnology precisely because
of the market-driven bent of our medical system.  Eye glasses and Insulin are
two of the many results of this.  If there are to be additions to the list in
the future, they certainly will not come about in a cost/benefit system of
socialized medicine.


					Terry Lambert
					terry_lambert@gateway.novell.com
					terry@icarus.weber.edu
---
Disclaimer:  Any opinions in this posting are my own and not those of
my present or previous employers.
Xref: sparky sci.med:14363 misc.education:2996