Matthew Bray
From Cyberlaw
Class One - George Annas
Professor Annas raised many thought provoking issues during his speech to the class. One thing that stuck out from the presentation was the overtly political tone of the discussion. It was a bit outside the norm of most lectures at HLS to see the professor’s political persuasion and beliefs so openly interwoven into the discussion. This forced me to think about the politics of bioethics, and how intertwined biotechnology is with the political process and government in general. So much of what we discuss in the realm of biotechnology involves governments imposing limits on the ability of private actors to engage in behaviors that at least some parties deem beneficial. Adam Smith’s “invisible hand” is not the ideal solution to the issues raised by Professor Annas because, as was demonstrated by the Nazi altitude experiments, there can be plausible explanations and benefits for doing unspeakable acts of harm to test subjects. Because there are no market solutions that private actors can work out on their own, the political process becomes a proxy by which these actors resolve their disputes. More importantly, the political process becomes the mechanism by which society agrees to collectively set boundaries for biotechnology.
With the current debate over stem cell research, many of the arguments are focused on the policies of the Bush administration, and Professor Annas made his beliefs about the Bush administration very clear. The real concern with allowing biotechnology development to be guided by the political process lies in the indirect path in which regulations get promulgated. Taking stem cell research as an example, few voters cast their ballots for their Senator or even the President based on their stated policies on stem cell research alone. A host of other factors are thrown in the decision, with the result being that a large swath of Americans may have voted for the current President and still be in favor of federally supported stem cell research. If a market-based approach to biotechnology regulation leaves test subjects open to exploitation, and the political process also proves to be inefficient at generating regulations that fit the norms and preferences of a majority of society, how should we go about tackling bioethics problems? I hope that the remainder of the course will shed some light on this issue.
Class Two - Teo Dagi
Mr. Dagi presented the case for biotechnology companies from the cold rational perspective on an investor. Initially, I was put off by his focus on money, but then I realized that these companies would not exist were it not for investors like him. The pursuit of returns by venture capitalists is what allows researchers to spend decades blowing through millions of dollars before they ever see a profit. Mr. Dagi put it bluntly when he said that anythign that the law does to limit investor returns, either through direct price controls or shorter patent terms would only end up hurting patients in the end because fewer drugs would get developed. One may not like this reality, but it is the choice we face with our current system of paying for heatlh care.
Class Three - Sheldon Krimsky
Professor Kirmsky's ideas are interesting but I think they suffer from an excess of paranoia and too little respect for poltical realities. Krimsky proposes that we nationalize the testing of pharmaceuticals because the corporate sponsored clinical trials are so skewed by the industry that they are full of false data. While there is little doubt that industry pushes the boundaries in trying to get drugs approved, Krimsky is discounting the huge staff of the FDA and also the oversight provided by the legal system and plaintiffs' bar. Likewise, Krimsky offers little in the way of a plan for implementing what would be an enormously expensive system. Nor did he address the fact that if such a systme were put into place, 50-75% of the cost of developing drugs would be taken away from pharmaceutical companies and paid for by someone else. If this were the case, consumers should expect drastically lower prices on pharmaceuticals, which is not likely to happen.
Class Six - Beverly Lorell
Dr. Lorrell did a wonderful job of answering our questions without facign the hard issues we were throwing at her. The one thing that she said that stick out to me was her focus on how wonderful the medical implant industry is because they can continuously improve their products, whereas drug manufacturers are stuck with the same compound for many years. This is clever corporate spin for reall saying that they are putting what are essentially experimental devices into people and constantly using human subjects as beta testors while they improve their product. She steered clear of addressing the coverup scandal where her company knew about defective batteries but held off notifiying physicians for a significant period of time. Overall, I did not get the impression that her primary concern was patient welfare.
Class Eight - Michael Sandel Professor Sandel kept the discussion going in an overall exciting class, but I can't help but feel that we did not really make any new insights in all of the discussion. Below are some of my running notes I took while listening and taking part in this class.
Sandel is very concerned about making genetic manipulations to enhance our children. We do this already in all other forms of society sorting out and trying to improve our children in every way – Feels like an alarmist to me.
I don’t buy that curing diabetes is different from choosing sex, or hair color, or choosing not to be short. – We are judging what is “important”, but that is a very subjective choice.
What about downs syndrome babies, we abort them now, but they can lead relatively normal lives. How is this different from genetic manipulation and selection before conceiving the embryo?
Identical twins example, they are not identical people – yet they have identical genes at the point of conception. Sandel is concerned about what we do in the test tube, but the nature vs. nuture debate has been going on for a long time and identical twins show that nuture plays a big part in making the person, even if two people have identical genes. Are the minor manipulations we make going to change this much?
Scope – how influential will this really be, and what about discrimination, is that a real problem if two people can always procreate in the natural way, then will we ever get to a point where enough people pay vast amounts of money to have a genetically "perfect" child. Besides, this technology will never reach the 90% of the world that won't have the money to afford or access this technology, so we are really concerned about only a very small portion of people here, not modifying all of humanity.
Deaf Child question – is that okay to create a deaf child – create a person in your image and what you want. My instinct is a complete NO. I am in a wheelchair due to an accident, is it okay for me to modify the genes of my child so they are born paralyzed and can be part of the wheelchair culture. This sounds callous, but putting it in these terms shows how crazy the deaf example is.
Steroids – are they that different – is it okay.
What about selecting race – that a basis for racist one race future?
Is it okay to create a person to fulfill your own desire to make a child in your image. We already do this to a large extent. Research shows we are attracted to mates who have similiar features to our own.
Sandel is making an artificial distinction about what is a medical distinction and what is “cosmetic”, and I don't think it can be decided on the basis of any objective criteria, these are just gut feelings judgments.
What the hell does Sandel mean with Medical versus Non-Medical uses – it is tautology
He draws the distinction about disability and design, and parents choosing traits that some consider to be positive and others consider a disability. This makes no sense.
He is against eugenics – what does that mean. For improvement but against eugenics, but that does not help us because one person's improving the human race is another person's eugenics.
Economic argument, - greatest good is achieved by improving people? Overall I am completely troubled by this class, if only because I don't think Sandel is answering any of our questions, only defelcting them wiht the skill of a master debater.
We have barely touched on the consent / corruption arguments that Sandel made in the Tanner Lectures
Sandel talks about certain parenting trends that he thinks are abusive, so he is concerned with this shaping of children outside the genetic modification before birth context.
We already do this choosing the best mate through evolution. Deformity and what we define as “ugly” are generally signs of weakness and health problems.
This class seemed to go in circles, and left me wiht more questions than answers, which may have been Professor Sanel's intentions.
