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What Price Better Health?

What Price Better Health?: Hazards of the Research Imperative

Copyright Date: 2003
Edition: 1
Pages: 341
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  • Book Info
    What Price Better Health?
    Book Description:

    The idea that we have an unlimited moral imperative to pursue medical research is deeply rooted in American society and medicine. In this provocative work, Daniel Callahan exposes the ways in which such a seemingly high and humane ideal can be corrupted and distorted into a harmful practice. Medical research, with its power to attract money and political support, and its promise of cures for a wide range of medical burdens, has good and bad sides-which are often indistinguishable. InWhat Price Better Health?,Callahan teases out the distinctions and differences, revealing the difficulties that result when the research imperative is suffused with excessive zeal, adulterated by the profit motive, or used to justify cutting moral corners. Exploring the National Institutes of Health's annual budget, the inflated estimates of health care cost savings that result from research, the high prices charged by drug companies, the use and misuse of human subjects for medical testing, and the controversies surrounding human cloning and stem cell research, Callahan clarifies the fine line between doing good and doing harm in the name of medical progress. His work shows that medical research must be understood in light of other social and economic needs and how even the research imperative, dedicated to the highest human good, has its limits.

    eISBN: 978-0-520-93923-3
    Subjects: Health Sciences

Table of Contents

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  1. Front Matter
    (pp. i-vi)
  2. Table of Contents
    (pp. vii-viii)
  3. Foreword
    (pp. ix-x)
    Daniel M. Fox and Samuel L. Milbank

    The Milbank Memorial Fund is an endowed national foundation that engages in nonpartisan analysis, study, research, and communication on significant issues in health policy. The fund makes available the results of its work in meetings with decision makers, reports, articles, and books.

    This is the ninth of the California/Milbank Books on Health and the Public. The publishing partnership between the fund and the press seeks to encourage the synthesis and communication of findings from research that could contribute to more effective health policy.

    Daniel Callahan is a profound and provocative participant in debates about appropriate health policy. He has observed,...

  4. Acknowledgments
    (pp. xi-xii)
  5. Introduction: An Imperative?
    (pp. 1-10)

    Recent years have seen an almost unprecedented level of excitement about medical research. The dramatic increases in the annual budget of the National Institutes of Health (NIH), running 10 to 15 percent a year, even as many other federal agencies’ budgets are being cut, reflect that excitement. So do reports of striking research progress and improved health traceable to research, along with the public’s enthusiasm over medical advances. Americans seem to have a special predilection for scientific progress, technological innovation, and better health. Hardly a doubt is voiced anywhere about the likely benefits of an ever greater commitment to research....

  6. 1 The Emergence and Growth of the Research Imperative
    (pp. 11-35)

    My first visit to Monticello, Thomas Jefferson’s remarkable Virginia home and enduring avocation, showed me far more than I expected. Like everyone else who has read about him, I was aware of the breadth and complexity of his mind: science, politics, history, law, agriculture, architecture, and philosophy just begin the list of topics that engaged him. Yet to see with my own eyes in his house the evidence of his range of theoretical and practical passions was still startling, books and gadgets side by side. At the center of it all was his bewitchment with science. “Nature,” he said, “intended...

  7. 2 Protecting the Integrity of Science
    (pp. 36-56)

    The research drive has the deepest possible roots, a defining part of what it means to be human. It helps us know ourselves, the nature of which we are a part, the ills of the body and mind. That drive now also connotes power and money and prestige, set within a network of politics, profits, and personalities that has of late brought dangerous viruses into the institution of science, joining those already present. In varying ways curiosity, ambition, hope, cupidity, and altruism motivate the scientific community that runs this institution. What are that community’s obligations? What does it need for...

  8. 3 Is Research a Moral Obligation?
    (pp. 57-84)

    In 1959 Congress passed a “health for peace” bill, behind which was a view of disease and disability as “the common enemy of all nations and peoples.”¹ In 1970 President Nixon declared a “war” against cancer. Speaking of a proposal in Great Britain in 2000 to allow stem cell research to go forward, Science Minister Lord Sainsbury said, “The important benefits which can come from this research outweigh any other considerations,” a statement that one newspaper paraphrased as outweighing “ethical concerns.”² Arguing for the pursuit of potentially hazardous germ-line therapy, Dr.W. French Anderson, editor in chief of Human Gene Therapy,...

  9. 4 Curing the Sick, Helping the Suffering, Enhancing the Well
    (pp. 85-113)

    The knowledge that biomedical research can bring, and the translation of that knowledge into clinical application, offers a proven way of making progress against the waywardness of the body and mind, assaulted from the inside and the outside by hostile agents of death, pain, and disability. Of late, the tantalizing possibility has been raised that research may also enhance our various human traits.

    We are all subject to our wayward bodies, though some are luckier than others or more blessed by access to good health care. But none of us gets a free pass from the body’s vulnerability to illness...

  10. 5 Assessing Risks and Benefits
    (pp. 114-132)

    The research imperative is a demand of human nature and an enormous social benefit. The drive for knowledge and the understanding it brings deserve strong public support. Even so, in its present manifestation, that imperative shows growing signs here and there of overreaching for success, of becoming obsessed in its drive for ever-greater scientific gains, of inclining toward that old god, Mammon. There are other, even more disturbing, signs of this trend. They include a keener aversion to moral limits or the serious social implications of research possibilities, and a proclivity for attacking or belittling those who question the research...

  11. 6 Using Humans for Research
    (pp. 133-164)

    When I was a philosophy graduate student I sought relief one day from the tedium of it all by wandering about the library where I worked, looking for something, anything, to wake me up. Close at hand were the proceedings of the Nuremberg trial in 1947, bringing to judgment the doctors turned killers in the service of the Nazi regime. I woke up. The accounts were electrifying. Medical researchers had turned the ethics of medicine on its head, their goal not to relieve death and suffering but to inflict them.

    Though I did not know it at the time, the...

  12. 7 Pluralism, Balance, and Controversy
    (pp. 165-200)

    Hardly anyone denies that medical research may along with bringing great benefits also on occasion open the way to harm, medical or social. What is to be done when debates about that possibility break out? The history of research, medical and otherwise, has notoriously been marked by controversies. Some turned on the scientific validity of research projects, while others turned on political, social, and ethical disagreements. The Galileo case, Pasteur’s work, Darwin’s theories, early experiments with anesthesia, or the struggle within physics over the use of nuclear weapons, are obvious examples. Even if controversies are not more numerous now, they...

  13. 8 Doing Good and Doing Well
    (pp. 201-234)

    There is nothing in business quite like the pharmaceutical industry. Enormously profitable, it is as widely praised as it is widely despised. It holds within its hands great health benefits and the power to corrupt in their pursuit. It brilliantly defends its turf and ruthlessly exploits its opportunities. It is the only industry that was able some years ago to capture the word “ethical” to bless its products, and the only one that has, without apology, defended its high, and always higher, prices as necessary to save lives and reduce suffering. Turning the research imperative into a high-powered generator of...

  14. 9 Advocacy and Priorities for Research
    (pp. 235-258)

    Although federal support for medical research has had its peaks and valleys, few governmental programs have been as enduringly popular. The crown jewel of that research is the National Institutes of Health, and of late the enthusiasm for its work has had uncommon bipartisan support in Congress. At the same time, the private sector’s pharmaceutical and biotechnology industries have benefited from strong sales, generating increased research enthusiasm as well, so much so that they now spend more on research than the government.

    Though few available public opinion surveys directly ask about research priorities, a recent survey on health priorities comes...

  15. 10 Research and the Public Interest
    (pp. 259-276)

    The aim of medical research is to better understand the human body and mind, and to make use of that knowledge to improve human health. My argument has been that the very importance of that research, its power to attract good scientists, to excite the public, to reduce pain and suffering, to turn a profit, and to offer tantalizing possibilities of human enhancement, opens the door to hazardous possibilities. Those possibilities coexist with the good that research brings. An intense commitment to research has its own problems. It falls into that category of human life where the good and the...

  16. Notes
    (pp. 277-308)
  17. Index
    (pp. 309-329)
  18. Back Matter
    (pp. 330-330)