The Book of Questions #5: Fatal Medicine

If a new cure for arthritis were developed that would cure arthritis but cause a fatal reaction in one percent of those who took it, would you want it to be released to the public.

The Book of Questions #3 by Gregory Stock, Ph.D. (1987)
elderly person during drawing therapy
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What does the question actually ask?

Most people would intuitively answer the question based on what they think they would do if they had arthritis. But the question is about if you want it to be released to the public not if you want to take yourself. So it assumes that you have to weigh the risks and benefits for other people. Something government agencies around the world do routinely. In essence the question wants you to think about the value of a healthy life versus the value of life with disease and pain (arthritis is joint pain / stiffness and can be quite debilitating).

But actually the question is not if you would want this medicine released to the public but rather if anyone should have the power to decide for the public. Now there is a point to be made for government oversight over the process of developing, testing and releasing a new pharmaceutical product. We (the public) do have an interest in safe and effective medicine. No one wants to to go back to the time when anyone could open up a pharmacy and sell your cocaine, heroine, amphetamines and the proverbial snake oil without safety and efficacy testing, good medical advice and proper dosage.

Who is going to weigh your risk and benefit?

But in our question the relative safety and efficacy have already been established. We know that it cures arthritis in 99% of cases and leads to death in 1% of the cases. Of course in the modern world some government agency will determine that this medicine is either safe enough or too risky for the public. They may even decide to just allow it in very serious cases. But do we need someone to have the power to make such a decision? We definitely want to make sure that we actually know the risks and benefits but once they are known why have someone decide for us?

Imagine you are an 82 year old woman with crippling arthritis but otherwise in decent health. You have children and grandchildren who visit you every week and except for the excruciating joint pain you could live a few more good years with some pleasures still left to you. Why would you not take that one percent risk? 99 out of 100 you get live a decent life until your eventual death. 1 out of 100 you had a good life and died maybe a few years early but then you also did not have to suffer from years of pain. For me personally it is a no-brainer.

Imagine you are a 35 year old man with two children who just started to develop arthritis. Conventional therapy will most likely alleviate your symptoms for a while and allow you to live a mostly normal life. Taking a 1 in 100 chance of dying and thereby cutting your life short by decades and making your children into orphans seems pretty risky for a disease that can be managed by conventional means. Also at your age you can reasonably hope for an improved version of the medicine that will be much safer.

Conclusion

For me it seems clear that no one should actually decide if such a medicine is made available to the public. Instead my preferred solution would be to ascertain the risks and benefits on any given medicine and to let doctors and patients together decide if the benefits outweigh the risks in each individual case.

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