More oversight IS a bad thing

Pauline Chen strikes again in the New York Times, claiming that her experience in transplant medicine shows that increased government oversight of medicine -- an inevitable consequence of government payment for medicine -- is not necessarily a bad thing.

Chen cites an example that frustrated her as a young doctor, in which she recommended surgery for a patient who had a small tumor. The insurance company didn't think the patient needed the surgery and balked at authorizing the surgery. Chen was frustrated at having a third party step into what was her and the patient's decision.

But then she goes on to say that it's not the third party that's the bad thing; it's only that when third parties aren't guided by the right evidence that the doctor-patient relationship breaks down. She cites the United Network of Organ Sharing, a semi-governmental organization that sets policies for organ transplants, as an example of how third party oversight can work.

She's wrong. If there is a grain of truth to her analysis, it's that government is needed to safeguard individual rights. Her example is that transplant doctors are not permitted to care for a donor patient and may not operate on that patient until he or she has died. This is supposed to prevent overeager transplant doctors from declaring a patient dead so as to get the organs into another patient as soon as possible. The donor patient certainly has a right to his own life, and if a doctor deliberately aborts that patient's care, even though the patient might live if properly cared for, he may be guilty of murder or at least criminal negligence. (The proper way to deal with the problem, however, is not third-party oversight to prevent wrongdoing, but rather stringent punishments for provable criminal actions.)

But Chen is wrong to extrapolate from transplantation (a situation in which individual rights might be violated) to all of medicine. She was absolutely right to be frustrated with the insurance company that second-guessed her decision; the insurance company was trying to substitute its judgment for hers and her patient's. At least in that case the third party making the decision was a private entity; the patient could have chosen, if treatment had been denied, to pay for the surgery herself, and in a free market she would have been free to seek a policy that better covered her actual needs. When that third party is the government, though, what recourse do we have? At best, you'll have to seek care outside the system (if you can afford it after you've been taxed to death to pay for the stimulus package); at worst, no alternatives will be available should the government secure a monopoly on healthcare.

Think about how you felt the last time you or someone you loved needed medical treatment and were denied because your insurance company deemed it medically unnecessary. Think about how it's going to be when the government gets to decide what is and is not medically necessary.

Wait a minute. WHO made history?

According to the Associated Press, "The Food and Drug Administration made history Friday as it approved the first drug made with materials from genetically engineered animals, clearing the way for a new class of medical therapies."

Please.

I'm not arguing that using genetically engineered animals as a new way to manufacture drugs isn't a great innovation. But the way the Associated Press puts it, you'd think the bureaucrats were the heroes. GTC Biotherapeutics, the company that actually made the breakthrough, isn't mentioned until paragraph 2, and then only to say that its spokesperson confirmed approval of the drug.

How is approval the act we should be celebrating? Much further down in the article, we finally get a glimpse at the methods GTC used to make its drug. It is these methods that are the real innovation and that are worthy of praise. All the FDA regulators had to do was review the data. It's GTC's scientists who did all the thinking, the lab work, the clinical studies that made this innovation possible.

Let's give credit where credit is due -- to the innovators, not the regulators.

Not enough encouragement

As Yahoo! News reports today, a donated kidney was removed via a woman's vagina for the first time at Johns Hopkins University last week. Traditional kidney removals cause significant scarring and a long recovery time; transvaginal removal cuts down on the pain of the procedure and the recovery time for the donor. Dr. Robert Montgomery, the leader of the team that performed the surgery, hopes that the new procedure will encourage more women to donate their kidneys, so that those waiting for transplants would be able to get a donated kidney faster.

Sorry, Dr. Montgomery. I don't think so.

I congratulate Dr. Montgomery and his team on their medical innovation, which I hope will make the lives of those women who do choose to donate a kidney easier. But let's face it: Giving up a kidney is still a difficult thing to do. Even with the shorter recovery time, it means a couple of weeks of giving up normal activities (not to mention income from time spent away from work); even the less traumatic operation is still invasive surgery, with its attendant risks of infection; and no matter what kind of surgery you have, you'll be spending the rest of your life with one kidney. That means no contact sports and no medications that have side effects on the kidney.

So, even with the lesser impact of the transvaginal surgery, I, for one, would need a whole lot more motivation than "you'll be saving the life of a stranger" to go through that procedure. You'll notice that the woman who had the operation was not giving her kidney up to the transplant list, to be assigned to someone she'd never met based on need. She gave it to her niece -- someone she presumably loves very much. In that case, giving up a kidney is not a sacrifice. She gave up a great value (her kidney) for a still greater value -- the life of someone she loves.

But how many people would be willing to make an actual sacrifice -- that is, giving up a kidney for a lesser value? The life of a stranger is of value to me only in the sense that I value human life in general. That is a much lesser value than someone whom I love personally for the virtues I know he or she possesses -- and because the value is lesser, what I am willing to give up for that value is also less. I would throw a life preserver to a drowning stranger at no cost to my own life -- but I wouldn't save his life at the cost of one of my kidneys.

So where does that leave the 78,000 people who are on the national waiting list for a kidney? They don't have a claim on the organs of healthy people, so are those who don't have a loved one willing to donate doomed simply to continue waiting -- sometimes until they die? There is a way we can help these people.

That way is to allow organ sales. Critics hate the idea of introducing money into what they believe should be a selfless donation -- of turning a one-sided gift into a mutual trade to mutual benefit. But it's incredibly presumptuous to decide that healthy people ought to be willing to give up an organ -- not to mention the time and money lost in having that organ removed -- to a stranger, for nothing more than a "thank you." And far from being heartless, allowing people to sell their organs would increase the supply of available kidneys -- which would help more people than forcing these transactions to be donations is doing now. A potential donor who would not give up her kidney to a stranger for nothing, might do it if by doing so she could finance her child's college tuition, or afford to take a sabbatical, or put a down payment on her first home. What is cold and heartless about that?

The achievement of the Johns Hopkins doctors is a wonderful thing that indeed could make kidney donations easier. Will it make a substantially larger number of women want to give up their kidneys? I doubt it. For that, we will need a free market in organ sales.