Tag: managers

Bioethics Blogs

Topsy-Turvy Brand Name Drug Pricing?

On August 7, 2017, The
New York Times
with ProPublica
(an independent, non-profit investigative new agency) reported
that some drug companies have struck deals with insurers to require that
prescriptions be dispensed for the more expensive brand name drug rather than
the less expensive generic alternative! Has the world turned upside down? What
has happened? Perhaps one could respond: Follow the money.

Pharmaceutical companies have apparently cut a deal with
health insurance companies and pharmacy benefits managers for some drug
products so that middle men pay prices that are very competitive, at least as
competitive as the generic equivalents. In one arrangement for a particular
drug – Shire’s Adderall XR, used to treat attention deficit hyperactivity
disorder (ADHD) – UnitedHealthcare insured patients were provided a discount
coupon which lowered the cost of the brand name considerably, but a patient’s
family still payed about $50 more a month than for the generic. Consumers
clearly are bearing the increased costs.

A spokesman for United Healthcare defended the program: “By
providing access to these drugs at lower cost, we are able to improve
affordability for our customers and members.” Of course, the statement is true,
but it is a poor justification because in this instance have no choice in the
matter. Even if patients’ physicians write for the generic equivalent, the
doctors are told that they “had to specify that patients required brand-name
versions of the drug.” This may or may not be true depending on the health
insurers’ and pharmacy benefits managers’ formulary requirements; but it may be
a moot point if the band name drug is the only one available, or unless the
patient wants to pay full price for a drug product that is not listed in the
formulary.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

Topsy-Turvy Brand Name Drug Pricing?

On August 7, 2017, The
New York Times
with ProPublica
(an independent, non-profit investigative new agency) reported
that some drug companies have struck deals with insurers to require that
prescriptions be dispensed for the more expensive brand name drug rather than
the less expensive generic alternative! Has the world turned upside down? What
has happened? Perhaps one could respond: Follow the money.

Pharmaceutical companies have apparently cut a deal with
health insurance companies and pharmacy benefits managers for some drug
products so that middle men pay prices that are very competitive, at least as
competitive as the generic equivalents. In one arrangement for a particular
drug – Shire’s Adderall XR, used to treat attention deficit hyperactivity
disorder (ADHD) – UnitedHealthcare insured patients were provided a discount
coupon which lowered the cost of the brand name considerably, but a patient’s
family still payed about $50 more a month than for the generic. Consumers
clearly are bearing the increased costs.

A spokesman for United Healthcare defended the program: “By
providing access to these drugs at lower cost, we are able to improve
affordability for our customers and members.” Of course, the statement is true,
but it is a poor justification because in this instance have no choice in the
matter. Even if patients’ physicians write for the generic equivalent, the
doctors are told that they “had to specify that patients required brand-name
versions of the drug.” This may or may not be true depending on the health
insurers’ and pharmacy benefits managers’ formulary requirements; but it may be
a moot point if the band name drug is the only one available, or unless the
patient wants to pay full price for a drug product that is not listed in the
formulary.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

In the Journals – June 2017, part two by Aaron Seaman

The first part of the In the Journals post for June 2017 can be found here. And now, for part two…

 

Medical Humanities

SPECIAL ISSUE: Communicating Mental Health

Introduction: historical contexts to communicating mental health

Rebecca Wynter and Leonard Smith

Contemporary discussions around language, stigma and care in mental health, the messages these elements transmit, and the means through which they have been conveyed, have a long and deep lineage. Recognition and exploration of this lineage can inform how we communicate about mental health going forward, as reflected by the 9 papers which make up this special issue. Our introduction provides some framework for the history of communicating mental health over the past 300 years. We will show that there have been diverse ways and means of describing, disseminating and discussing mental health, in relation both to therapeutic practices and between practitioners, patients and the public. Communicating about mental health, we argue, has been informed by the desire for positive change, as much as by developments in reporting, legislation and technology. However, while the modes of communication have developed, the issues involved remain essentially the same. Most practitioners have sought to understand and to innovate, though not always with positive results. Some lost sight of patients as people; patients have felt and have been ignored or silenced by doctors and carers. Money has always talked, for without adequate investment services and care have suffered, contributing to the stigma surrounding mental illness. While it is certainly ‘time to talk’ to improve experiences, it is also time to change the language that underpins cultural attitudes towards mental illness, time to listen to people with mental health issues and, crucially, time to hear.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

In the Journals – May 2017 by Livia Garofalo

Please enjoy the article round-up for the month of May! This post was put together in collaboration with Ann Marie Thornburg.

American Ethnologist

Plant matters: Buddhist medicine and economies of attention in postsocialist Siberia

Tatiana Chudakova

Buddhist medicine (sowa rigpa) in Siberia frames the natural world as overflowing with therapeutic potencies: “There is nothing in the world that isn’t a medicine,” goes a common refrain. An exploration of sowa rigpa practitioners’ committed relations with the plants they make into medicines challenges human-centric notions of efficacy in anthropological discussions of healing. Their work of making things medicinal—or pharmacopoiesis—centers on plants’ vital materialities and requires attention to the entanglements among vegetal and human communities and bodies. Potency is thus not the fixed property of substances in a closed therapeutic encounter but the result of a socially and ecologically distributed practice of guided transformations, a practice that is managed through the attentive labor of multiple actors, human and otherwise. In Siberia, pharmacopoiesis makes explicit the layered relations among postsocialist deindustrialization, Buddhist cosmologies, ailing human bodies, and botanical life.

Annals of Anthropological Practice

Special Issue: Continuity and Change in the Applied Anthropology of Risk, Hazards, and Disasters

Disaster vulnerability in anthropological perspective 

A.J. Faas

In the study of disasters, the concept of vulnerability has been primarily employed as a cumulative indicator of the unequal distributions of certain populations in proximity to environmental and technological hazards and an individual or group ability to “anticipate, cope with, resist and recover” from disaster (Wisner et al. 2004). This concept has influenced disaster research as a means to question how natural, temporary, and random disasters are and focused analysis on the human-environmental processes that produce disasters and subject some populations more than others to risk and hazards.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

Incidental White Privilege

STUDENT VOICES

By Jade Reyes

Not every issue of morality that we are faced with is easily discernible— with an easily ascertainable correct action. Many of these issues are nuanced and multifaceted, affecting every person differently and involves a weighing process between imperfect alternatives. One of those issues is race or ethnicity and furthermore the perceptions and assumptions that come hand in hand. Race and racial prejudice are intricately woven into the fabric of American history. While the most prominent struggle between Whites and Blacks is entrenched in the legacy of slavery, another more subtle battle persists. This battle, in my personal experience, blurs the line of ethical and moral behavior in many settings; particularly social and business relations. This struggle is the plight of those who pass for another race– specifically those non-Whites who may be perceived as White, such as myself. This presents a unique moral and ethical challenge: having to toe the line between my ‘by chance’ white privilege and allegiance to my ethnic background.

Often the struggle to which I refer is given the name of colorism, in which light skin tones are preferred and fare better in arbitrary categories when compared to darker skin tones. There is this persistent trend; according to the historical record that having lighter skin regardless of your racial or ethnic origin is a good thing— a door opener if you will. For fair-skinned Latinas like myself, the identifier of white is available to me, but it comes as a powerful oxymoron to define myself as a white-Latino.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

Incidental White Privilege

STUDENT VOICES

By Jade Reyes

Not every issue of morality that we are faced with is easily discernible— with an easily ascertainable correct action. Many of these issues are nuanced and multifaceted, affecting every person differently and involves a weighing process between imperfect alternatives. One of those issues is race or ethnicity and furthermore the perceptions and assumptions that come hand in hand. Race and racial prejudice are intricately woven into the fabric of American history. While the most prominent struggle between Whites and Blacks is entrenched in the legacy of slavery, another more subtle battle persists. This battle, in my personal experience, blurs the line of ethical and moral behavior in many settings; particularly social and business relations. This struggle is the plight of those who pass for another race– specifically those non-Whites who may be perceived as White, such as myself. This presents a unique moral and ethical challenge: having to toe the line between my ‘by chance’ white privilege and allegiance to my ethnic background.

Often the struggle to which I refer is given the name of colorism, in which light skin tones are preferred and fare better in arbitrary categories when compared to darker skin tones. There is this persistent trend; according to the historical record that having lighter skin regardless of your racial or ethnic origin is a good thing— a door opener if you will. For fair-skinned Latinas like myself, the identifier of white is available to me, but it comes as a powerful oxymoron to define myself as a white-Latino.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

In the Journals – April 2017 by Danya Glabau

Critical Public Health

On difference and doubt as tools for critical engagement with public health

Catherine M. Will

This paper argues that critical public health should reengage with public health as practice by drawing on versions of Science and Technology Studies (STS) that ‘de-centre the human’ and by seeking alternative forms of critique to work inspired by Foucault. Based on close reading of work by Annemarie Mol, John Law, Vicky Singleton and others, I demonstrate that these authors pursue a conversation with Foucault but suggest new approaches to studying contemporary public health work in different settings. Proposing that we ‘doubt’ both the unity of public health and its effects, I argue that this version of STS opens up a space to recognise multiplicity; to avoid idealising what is being criticised; and to celebrate or care for public health practices as part of critique. Finally I oppose the view that considering technologies, materials and microbes leads to micro-level analysis or political neutrality, and suggest that it allows us to reframe studies of public health to account for inequalities and to draw attention to weak or retreating states, active markets and the entangled relations of humans and non-humans across the world.

 

Biopolitical precarity in the permeable body: the social lives of people, viruses and their medicines

Elizabeth Mills

This article is based on multi-sited ethnography that traced a dynamic network of actors (activists, policy-makers, health care systems, pharmaceutical companies) and actants (viruses and medicines) that shaped South African women’s access to, and embodiment of, antiretroviral therapies (ARVs).

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

Paid Sick Days: The Better Way

Kelly Holloway describes how changes to business practices concerning sick days can be beneficial for workers’ health and the economy.

__________________________________________

Most employees understand the case in favour of paid sick days. If you do not have them, you probably have to choose between staying home sick and losing pay or going to work sick and putting other people’s health at risk. But the steadfast counter argument to the campaign for paid sick days is that businesses suffer, especially small businesses. And when businesses suffer, the economy suffers.

A newly formed alliance, the Better Way to Build the Economy Alliance, is challenging the argument that legislated paid sick days are bad for the economy. It is doing so by bringing together employers who feel that paid sick days are actually good for businesses. More than that, the alliance claims that decent working conditions and a better minimum wage are good for the economy. This alliance of businesses and community leaders is helping to prove that investments like paid sick days and better wages result in higher levels of employee productivity and customer satisfaction.

“In a small business, you know your employees, and it’s rare, rare, that someone will abuse a paid sick day,” says Paul Hayman from Five Walls Realty in Guelph. “In fact, in my experience most of the time you have to tell someone to go home because they’re feeling sick.”

Toronto, 2016. Photo Credit: Kelly Holloway

Hayman, along with other employers, is featured in the Better Way videos, launched earlier this month.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics News

A halfway house in the conscientious objection debate

Conscientious objection has come under fire recently, and several leading bioethics journals have published articles criticising healthcare professionals who object to participation in controversial procedures.

The latest addition to the literature, an article published online first in the Journal of Medical Ethics this week, criticises “conscience absolutists” who suggest that even the most remote forms of cooperation in pregnancy termination constitute licit grounds for conscientious objection.  

In his article “Conscientious objection in healthcare and the duty to refer”, University of Dublin bioethicist Christopher Cowley argues in favour of current UK abortion regulations, which permit conscientious objection, though only under certain conditions. NHS guidelines allow clinicians to abstain from participation in terminations, but nevertheless requires them to provide “reliable information” to patients about abortion services they could use.

Against “conscience absolutists”, Cowley argues that objecting doctors, as representatives of the NHS system, have a duty provide “reliable information” to patients about abortion services. Importantly, he argues that mere provision of information does not constitute formal cooperation in the procedure.

“the provision of information is not a necessary or indispensable link in the chain of actions leading to the abortion, since, after receiving the information, the patient leaves the NHS space and becomes a free agent, ready to make her…own decisions.”

Cowley argues that abortion is a “contestable” ethical issue, in the way that something like the Rawandan geocide was not.

In light of the reasonable disagreement that we have over abortion, conscientious objectors must acknowledge the rights of healthcare professionals and indeed patients, to act in accord with their ethical beliefs about pregnancy terminations.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

Web Roundup: Water by Lily Shapiro

Before I began graduate school, I worked in water-related public health, and have continued to follow the news around water. This month, some stories (mostly) about water.

Trump signed an order last week to “expedite” the construction of the Dakota Access Pipeline, which jeopardizes the water source for the Standing Rock Sioux Reservation, and for many others who drink water from the Missouri River. Opponents of the pipeline are not surprised, and are gearing up for a fight. Although most of Silicon Valley has come out against Trump (though perhaps in somewhat tepid terms), particularly in light of his recent executive order on immigration, Peter Thiel has been tapped to help Trump pick someone to lead the FDA, with the goal of decreasing its regulations around drug approval process. Vox goes into detail about why that’s a bad idea. (And, before we move away from the topic of Trump’s horrifying first week in office, if you haven’t read CultAnth’s interview with prof of anthropology and lawyer Darryl Li on the travel ban, I recommend it).

California has recently gotten some much-needed rain (and snow) this month. Researchers and farmers there are experimenting with methods, which include flooding fields during the winter, to use this rain to recharge the depleted groundwater aquifers. Also, check out this time lapse of the California drought from 2011-present. The storms also toppled an iconic, if controversial, “drive-through” Sequoia tree, one of the last still standing in a public park.

Meanwhile, the state of Tamil Nadu, in South India, is experiencing its worst monsoon in nearly 150 years, a crisis worsened by the demonetization on November 9 (in which the Rupees 500 and 1000 notes were declared invalid), resulting in the deaths of numerous farmers and recent agitations by farmer’s groups.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.