Wednesday, December 03, 2008 - Posts
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Good front-page article in today's New York Times on Britain's National Institute for Health and Clinical Excellence (NICE), which, among other things, decides whether a few more months of your life are worth the expense. The article begins with a guy named Bruce Hardy who needs a drug that might give him an extra half-year of life but would cost $54,000. NICE said no. The agency comes off as heartless. "Everybody should be allowed to have as much life as they can," Hardy's wife pleads. The article concludes: "Meanwhile, Mr. Hardy waits. In recent weeks his growing tumor has pressed on a nerve that governs his voice. He can barely speak and is increasingly out of breath."
Aw, hell. It'd be great if we could buy an extra half-year for everybody. But we can't. We have unmet needs everywhere. People die every day from being uninsured and unattended. They just don't make the front page.
There's a cruel bias built into our minds that makes you feel more for the person who's suffering in front of you than for people whose suffering appears only in statistical form. (I can't remember what the psychologists or economists call this bias. If you do, please share it with the class.) So now you know all about Bruce Hardy, and you probably regard the bureaucrats at NICE as cads for stiffing him. It's harder to remind yourself of all the health and added life that $54,000 could buy for others. For example: Where does the Gates Foundation send its medical dollars for maximum efficiency? Childhood vaccines.
As far as I can tell, NICE is doing good work. Its refusal to pay any amount for life-prolonging drugs has forced drug companies to cut prices. And by drawing a line against paying too much in some tragic cases, NICE preserves money for other cases where the money can do more good. If anything, NICE is a bit soft. For instance, the Times reports: "After consulting a citizens group, the institute decided that the nation should spend the same amount saving or improving the life of a 75-year-old smoker as it would a 5-year-old." If I ran NICE, the 5-year-old would take priority. And I'm irked to see that NICE is already backing off from its rejection of cases such as Hardy's. According to the Times, this comes after NICE was "flooded with anguished comments." I'm sorry, but anguish is everywhere. If patients like Hardy get funded at $9,000 per month, which other patients won't be funded? What about their anguish? Or does your anguish count only if you have the means and know-how to lobby the government?
Yes, everybody deserves as much life as possible. But that means the person in front of you can't take an undue share of limited public funds when others are in need.
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I forgot to do something Monday that I need to start doing from now on: posting an item here each time I write a longer essay in Slate. The item here will just link to the essay and summarize it. Or maybe it'll just be the opening paragraph or something. The reason I'm doing this is to simplify things so you don't have to go to two different places, or subscribe to two different RSS feeds, to get the latest Human Nature whatever. Last spring I set up a network of separate HN pages. Result: The more clicks readers had to go through to find each page, the lamer the traffic got. My tentative conclusion: You're busy, and you don't have time to go poking around looking for a lot of stuff, and my job is to make it easier for you to find what interests you in one place. So: Here it is. You can read the short stuff here, and the longer stuff, and eventually we'll have blog software that will let me post more links to outside pieces, in case you're into that.
If you want to RSS this page, you can use the RSS or Atom links on the right. Or you can bookmark it using the URL at the top: http://www.slate.com/blogs/blogs/humannature/default.aspx. Or, for those of you who prefer a URL that's easier to remember and type (as I do), I just bought humanature.com (one N—all the double-N humannatures were taken), so you can just type "humanature" in your browser window, hit control-enter, and it'll bring you here.
Now, here's the link to Monday's piece. It's about a test that's being marketed to parents to tell them which version of a "sports gene" their kid has. I called this an early version of environmental eugenics or "envireugenics." The language guardians at Commentary have already criticized this as a misnomer and an "ugly Greco-Latin hodgepodge"—the sort of response that, when I've delivered it, has prompted my wife to dismiss me as a "usage pedant." So clearly I'm among friends.
Misha Angrist, the delightfully acerbic "Genome Boy," has also posted in response, which completes our mutual name-check, since in part I was responding to him in the first place. I wrote in Monday's piece that the company behind the new gene-testing pitch, Atlas Sports Genetics, was peddling "national greatness." Angrist replies, "I suspect these companies are more interested in making a killing than they are in 'national greatness.' " (He also says he'd write to me if Slate were "less covetous of its reporters' email addresses." This I have to take from a guy who doesn't put his name on his site? Misha, the least I can do is trade you my e-mail address for your genome. The reason I don't post it is that I once gave it out to a newsletter for PR companies, and now I spend 10 minutes a day fending off e-mails from PR companies. It's in the mail.)
The problem I keep having with Angrist is that I want to quibble with his interpretations, but I can't find fault with his facts. I'm sure he's right that Atlas is in this for the money. I guess what I'm arguing is that in a situation like this, there are two motives: the private one and the public one. Here, the private motive is profit. The public motive is national greatness. The public motive is the one the company presents to potential customers who visit its Web site. This is literally the only message on its home page: "Finding any great Olympic champion normally takes years to determine. What if we knew a part of the answer when we were born?"
Olympic champ? That's a pretty extreme standard to throw at parents up front. Maybe the company thinks there are a lot of parents who seriously envision their kids winning Olympic events. (I envision my kid's soccer team winning more than one game next spring.) But my guess is that the company also feels some obligation to make its public pitch fit the scientific evidence behind the test. And the evidence doesn't show genetic differences in athletic performance at childhood or even ordinary adult levels. It shows such differences at the level of international meets.
I'm not saying the public motive excludes the private one. It's already clear from Sunday's New York Times story that funneling kids toward national greatness is part of Atlas' business plan. I'm just saying that the two motives can operate in tandem, or at least side by side.
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