Value-based pricing: a controversial narrative

 Rethinking value in health innovation: from mystifications towards prescriptions

From the abstract:

Debates over value in health innovation in the U.S. and Europe have
become increasingly dominated by “value-based pricing”. We examine
this prevailing narrative and its weaknesses and then present an
alternative framework for rethinking value in health. Drawing on
scholarship from the political economy of innovation, we argue that
value in health must be considered in terms of both value creation
as a collective process amongst public and private actors, as well as
value extraction that occurs due to financialization. In building this
alternative framework, we pose three questions that present areas
for further research and public policy change

Precision medicine (2)

 Advancing Healthcare Through Personalized Medicine

AI everywhere (16)

 The Doctor and the Algorithm. Promise, Peril, and the Future of Health AI

AI is a clear and present danger to health, safety, and equity. AI also has the potential to improve clinical care profoundly. Both of these statements are true, and both are false by dint of their incompleteness. This kind of indeterminacy is a common problem in medicine. Famously, pharmakon (the Ancient Greek word at the root of pharmacy) means “drug” but can connote either cure or poison. The Paracelsian maxim that “the dose makes the poison” is likewise a common, albeit misleading, trope of introductory pharmacology. In many ways, AI is a pharmakon. It can be both cure and poison. The indeterminacy of a pharmakon is inarguably a challenge for medicine, but it does not bring healthcare to a halt. Rather, doctors, researchers, and regulators have slowly built up, over the centuries, systems of checks and balances that ideally lead toward more pharmakon-qua-cure than pharmakon-qua-poison. Please do not misunderstand me. This has certainly not been some sort of steady progression toward a better world. I am not trying to sell a story about the inevitability of scientific progress.

Health reform zombies (3)

 Health Reform Without Side Effects: Making Markets Work for Individual Health Insurance

Pandemethics (2)

 Pandemic Bioethics

Contents:
Chapter 1 Historical Epidemics
The Spanish Flu of 1918
Cholera
Plague
Smallpox
Yellow Fever
Malaria
Chapter 2 Modern Viral Pandemics
Polio
Asian Flu of 1957 and Hong Kong Flu of 1968
Ebola
Swine Flu of 1976
Human Immunodeficiency Virus (HIV)
SARS1
Swine Flu of 2009
Middle Eastern Respiratory Syndrome (MERS)
Zika
Other Viral Diseases Affecting Humans
Chapter 3 The Medical Nature of SARS2
Disputed Origins of SARS2
The Clinical Course of COVID-19
Transmission and Immunity
Chapter 4 Policies for Containment
Quarantine as a Preventive Allocation Strategy
Four Models of Fighting Pandemics
Successes and Failures around the World
Intermittent Lockdowns, Denial, and the American Confusion
Chapter 5 Who Should Live When Not All Can?
Ethical Theories as Guides
Historical Background: The God Committee and Social Worth
A Relevant Digression: “Sickest First” Allocation and UNOS
Enter Bioethicists
Saints and Sacrifice
Covid, Cognitively Challenged Patients, and Rights of Disabled Persons
Unexpected Allocation Issues
Chapter 6 Developing Vaccines
A Brief History of Vaccines
Kinds of Vaccines
Ethical Issues in Developing Vaccines
Speeding Up Development of Experimental Vaccines
Other Problems with Vaccine Trials
Politics and Vaccines for Covid
Chapter 7 Allocating Vaccines
Success with Quick Production of Vaccines
The CDC and the States
Ability to Pay and Access to Vaccines
Allocation Priorities
Vaccination Complexities
Mandatory Vaccinations
Global Vaccine Distribution
Possible Bad Scenarios
Chapter 8 Acts and Omissions, the Trolley Problem, and Prisoner’s Dilemmas
Acts vesus Omissions
The Trolley Problem
Prisoner’s Dilemmas and Vaccination Uptake
Chapter 9 Liberty and Privacy
Philosophical Positions on Liberty
Problems of Contact Tracing
Controlling Pandemics versus Protecting Privacy
Privacy of Genetic Information Collected during Testing in Pandemics
Chapter 10 Status Certificates
Defining Key Terms
What Is the Purpose of Status Certificates?
Benefits of Status Certificates
Problems with Status Certificates
Chapter 11 Structural Inequalities and Vulnerable Groups
Who Is Most Vulnerable in a Pandemic?
Differences in Efforts to Control Infection in Different Vulnerable Groups
Chapter 12 Leadership during Pandemics
Leadership and the Virtue of Trust
The WHO’s Leaders Made Mistakes
Donald Trump and American Leadership
Judgment of US Leaders during the Pandemic
Chapter 13 The Future
The Future of COVID-19
Lessons to Learn
More Pandemics Will Come
What Will Happen Next?

Decentralization in healthcare

 Federalism and Decentralization in Health Care. A Decision Space Approach

The ableist conflation

 The Life Worth Living. Disability, Pain, and Morality

The central argument of this book can be stated simply: the canonical idea that some lives are not worth living results from the ableist conflation of disability with pain and suffering. That is to say, the reason for this entrenched, tradition-spanning idea is the habit of thought wherein one conflates experiences of pain and suffering with experiences of disability—experiences whose form, mode, matter, or style of living is considered categorically outside ableist norms.

I offer the ableist conflation as a concept to capture the underlying presuppositions that guide ableist discourses and practices in philosophy; ethics; politics; medicine; local, national, and international policy; and beyond. Although it can take many forms, the ableist conflation involves some variation of at least the following four claims:

1. Disability necessarily involves a lack or deprivation of a natural good.

2. Deprivation of a natural good is a harm.

3. Harm causes or is itself a form of pain and suffering.6

4. Given 1–3, disability comes along with or directly causes pain and suffering.

The ableist conflation functions in part by capitalizing upon the ambiguity of the array of terms it involves. Disability, harm, pain, and suffering are all uncritically underdefined, as are the relations between them. A central goal of this book is to decouple disability and pain through phenomenological investigation and, by doing so, to dismantle the ableist conflation and the uncritical assumptions behind each of its operative terms.

Do no harm

 Ante todo no hagas daño

Can capitalism be reimagined ?(5)

 Woke Capitalism. How Corporate Morality is Sabotaging Democracy

The Oxford dictionary’s definition woke refers to being ‘well informed’ or ‘alert to racial or social discrimination and injustice’.

Essentially, we have two opposing positions. One, from a liberal left position such as Elizabeth Warren’s, agrees that corporations should genuinely and authentically support the broad interests of society rather than just focusing on shareholders. Another, from a traditional right-wing perspective, believes that corporations should be purely economic entities and not interfere directly in social or political matters. This book has taken a third position. That is, despite how it looks on the surface, corporate engagement with progressive politics is harming democracy and preventing actual progress. What this means is that being critical of woke capitalism does have to necessitate a dismissal of  progressive politics. Waking up to the realities of woke capitalism means not being fooled into thinking that it represents any genuine underlying change to the primary interests that capitalist corporations are willing or able to pursue.

The real effects of woke capitalism are not about the success of left activism in gaining support from big business. They are about ensuring that there is no fundamental reform of the dominant neoliberal world order that has exacerbated inequality, fuelled fascist populism, and stood by as the climate crisis escalates. Dismissing woke capitalism as just another example of virtue signalling is counterproductive in that it fails to take seriously the real damage that woke capitalism can do. Laughing at corporate progressiveness as a superficial and inauthentic business practice entirely underestimates its real power. This is not simply about the short-term profitability assumed by the ‘go woke, or go broke’ credo. Going woke is about ensuring that market capitalism can continue on the trajectory that it has been on for the past 40 years. Woke capitalism is a strategy for maintaining the economic and political status quo and for quelling criticism.

Against patents, again (3)

 Patent Politics. Life Forms, Markets, and the Public Interest in the United States and Europe

Comparing battles over patents on animals, human embryonic stem cells, human genes, and plants in the United States and Europe, she shows how political culture, ideology, and history shape patent system politics. Clashes over whose voices and which values matter in the patent system, as well as what counts as knowledge and whose expertise is important, look quite different in these two places. And through these debates, the United States and Europe are developing very different approaches to patent and innovation governance. Not just the first comprehensive look at the controversies swirling around biotechnology patents, Patent Politics is also the first in-depth analysis of the political underpinnings and implications of modern patent systems, and provides a timely analysis of how we can reform these systems around the world to maximize the public interest.

Against patents (2)

 Medical Monopoly. Intellectual Property Rights and the Origins of the Modern Pharmaceutical Industry

Medical Monopoly combines legal, medical, and business history to offer a sweeping new interpretation of the origins of the complex and often troubling relationship between the pharmaceutical industry and medical practice today. Joseph M. Gabriel provides the first detailed history of patent and trademark law as it relates to the nineteenth-century pharmaceutical industry as well as a unique interpretation of medical ethics, therapeutic reform, and the efforts to regulate the market in pharmaceuticals before World War I. His book will be of interest not only to historians of medicine and science and intellectual property scholars but also to anyone following contemporary debates about the pharmaceutical industry, the patenting of scientific discoveries, and the role of advertising in the marketplace.

 

On epigenetics and health (2)

 The Epigenetics Revolution. How Modern Biology Is Rewriting Our Understanding of Genetics, Disease, and Inheritance

The ‘epi’ in epigenetics is derived from Greek and means at, on, to, upon, over or beside. The DNA in our cells is not some pure, unadulterated molecule. Small chemical groups can be added at specific regions of DNA. Our DNA is also smothered in special proteins. These proteins can themselves be covered with additional small chemicals. None of these molecular amendments changes the underlying genetic code. But adding these chemical groups to the DNA, or to the associated proteins, or removing them, changes the expression of nearby genes. These changes in gene expression alter the functions of cells, and the very nature of the cells themselves. Sometimes, if these patterns of chemical modifications are put on or taken off at a critical period in development, the pattern can be set for the rest of our lives, even if we live to be over a hundred years of age.

There’s no debate that the DNA blueprint is a starting point. A very important starting point and absolutely necessary, without a doubt. But it isn’t a sufficient explanation for all the sometimes wonderful, sometimes awful, complexity of life. If the DNA sequence was all that mattered, identical twins would always be absolutely identical in every way. 

Covid-19 response

 Covid-19. La respuesta autoritaria y la estrategia del miedo

Pharma, big pharma (14)

 Global Pharmaceutical Policy