Morning Ethics Warm-Up, 12/12/2017: Idiotic Roy Moore Endorsement, Irresponsible Drug, Incompetent Ethics Study…

Yeah, right…

1 Idiot’s Delight. It seems unkind to say, but today we will learn just how many idiots there are in Alabama. That’s useful information for any state, don’t you think? There is literally no non-idiotic justification for voting for a man like Moore, with his record, to any elective office, much less the U.S. Senate. Yet I strongly suspect he will win, and the disproportionately Democratic and liberal tilt of the those exposed in the Harvey Weinstein Ethics Train Wreck will have been the tipping point.

Here is a jaw-dropping example of the level of intellectual rigor expected of Moore voters.

At an election eve Moore event,  one of the speakers was Bill Staehle, who served with Moore in Vietnam. As an endorsement of Moore, Staehle told the tale of a fellow soldier comrade of both men who  invited them to accompany him to a private club in Saigon to celebrate the man’s final night there. The third man drove them to the club in his Jeep, but when they arrived, Staehle told the crowd, it became clear that they were at a brothel, and that their colleague had tricked them.

“There were certainly pretty girls. And they were girls. They were young. Some were very young,” Staehle said. Here is the point of the story: Moore was shocked by what he saw, Staehle claims. “We shouldn’t be here, I’m leaving,” Staehle, quoted the future disgraced judge and absurd Senate candidate as saying. They both left, leaving their friend stranded with underage prostitutes all night.

The moral of the story: “He’s the same guy… He’s honorable. He’s disciplined. Morally straight. Highly principled.”

Hey, I’m convinced!

The story, of course, proves nothing relevant to Moore’s character at all, and if Staehle thinks it does, he’s an idiot.

Staehle hadn’t seen Moore in 45 years, and this was a single incident. How does he know “He’s the same guy”? Besides, the anecdote tells us nothing about Moore’s character. Who knows why Moore left? Maybe he didn’t want to pay for sex with young girls, knowing that he could get plenty free once he got back to Sweet Home Alabama. Maybe he wasn’t attracted to Asian girls. Maybe he was afraid of getting a disease.

Only an idiot would find Staehle’s logic persuasive….but that is the target group, I guess.

2. Filed in the “Wait…WHAT?” binder. Spinal muscular atrophy is a rare genetic disease that interferes with the body’s ability to make the survival motor neuron protein. Victims of the disease lose muscle control and strength, and eventually the ability to move, swallow or breathe. The most common type of the disease is diagnosed in babies between birth and 6 months old.

The Food and Drug Administration approved the first drug to treat spinal muscular atrophy a year ago. It’s called Nusinersen, and is injected into the spine, temporarily enabling spinal muscular atrophy patients to make more of the survival motor neuron protein. An article in Science Daily says that the drug has raised “ethical concerns.” Why, you ask?

A single dose of the drug costs $125,000, and six injections are required in the first year, for a cost of $750,000. Three more are required in subsequent years, at a cost of $375,000 a year. Nusinersen isn’t even a cure at that price.  Most babies diagnosed with the disorder die before their second birthday, even with the drug.

A non-cure drug that costs that much for a single doomed patient is not ethical by definition. The Science Daily article goes into related ethical issues like this one:

[C]linicians have encountered cases in which insurance companies cover the medication only for the younger of two siblings because the older child has more disabilities and so doesn’t meet their criteria for covering the progressive disorder. “I don’t know what it’s like to be that parent and to have the joy at the opportunity to potentially modify one child’s life, and not have the opportunity for your slightly older child. It’s a very cruel time, I think,” [a bioethecist] said.

Wait…What? It’s unethical to spend that amount of money on treatment for a single patient that won’t even save his life. It’s unethical for others to have to pay higher insurance premiums to cover the costs of such a drug. When does a drug become so expensive that it might as well not exist at all? Whatever that point is, Nusinersen passed it.

3. Speaking of research ethics…An Ohio State researcher named Jay Zagorsky published a classic example of why social science research is inherently suspect. His goal, he writes, is to determine the connection between ethical behavior and financial success. “Is there is a relationship between the two?”, he asks.

Ugh. In his article about his research, Zagorsky makes it clear that he doesn’t understand ethics, life, or research. Hear are some of his statements:

“Television is filled with shows such as “Game of Thrones,” “Mad Men,” “House of Cards” and “Boardwalk Empire” in which the main characters have reached financial success using underhanded means. While these shows are entertaining, they are fiction and cannot reveal if actually engaging in unethical behavior systematically improves a person’s financial situation.”

“If financial success leads to less ethical behavior, then society needs more rules and punishment for richer people than for poorer people.”

“If the argument is that the poor are more likely to break ethical standards, then perhaps more rules and punishment are needed for those who are unsuccessful financially.”

“If causation runs the other way and more ethical behavior leads to financial success, then people have a reason to do good, without needing to assume there is a heavenly reward after death or be deterred by threats of punishment on Earth. However, if less ethical behavior leads to financial success, then punishment should not only fit the crime but also the financial status of the guilty.”

No useful research can come from a study designed by someone this clueless about what he’s researching.

You see, Jay, ethics is largely defined by whether conduct benefits society as a whole, by establishing and strengthening standards that lead to more people leading happy, free, productive lives. Conduct that one engages in to benefit one’s own circumstances are motivated by non-ethical considerations. Whether an ethical act has financially beneficial consequences is determined by moral luck.

Jay’s conclusions after his “study”:

Surprisingly, I found little correlation between either set of behaviors and wealth when respondents were younger. Small ethical breaches such as stealing less than $50 and appearing honest to the interviewer seem to have no impact on wealth accumulation. This suggests small ethical breaches do not have large financial impacts for most people. There also was no relationship between financial wealth and being honest with a cashier or helping the homeless. While this suggests small acts of kindness won’t lead to great material wealth, at the least there appears to be no financial penalty….However, larger ethical breaches and wealth do have a clear negative relationship. Breaking rules, stealing and being arrested were associated with less wealth. Moreover, the older the respondents got, the clearer the association between these unethical behaviors and having less money.

Unfortunately, the direction of causation is unknown, so it is uncertain if breaking rules causes less wealth or being poor causes people to break rules.

I think Jay Zagorski would be a good bet to vote for Roy Moore, if you know what I mean….





37 thoughts on “Morning Ethics Warm-Up, 12/12/2017: Idiotic Roy Moore Endorsement, Irresponsible Drug, Incompetent Ethics Study…

    • Spot on Tex. We now have yet another reason to be happy that I don’t live in Alabama* since I don’t have to pick from these two. This election is yet another replay of the presidential one where there is no good, ethical answer. I don’t think I need to repeat why voting fro Moore is bad, even without the women. But to enable “the resistance” to undermine the constitution isn’t a good idea either.

      *In the interest of full disclosure, I’ve only flow over Arkansas, Mississippi and Alabama. So I have to rely on other’s depictions on what’s is like there when I say I have no interest in living there. OTOH, I have been in Louisiana, Northern Florida, Georgia and Tennessee so it’s probably not far off.

        • This was the dream anti-GOP election. If the Republican won, it meant that all of the party was pro-teen-molesting. If the GOP lost, it was a rebuke of Trump. I can predict the spin.

          The most ridiculous, dishonest, untrustworthy, 15th Century fool ever to run for the US Senate since the end of legal segregation lost by less than 1%, but he lost, as he should have if he were running against Lassie. Any spin is gratuitous.

  1. 2) I wonder what constructs exist in our nation that make drug prices so damn high?

    I wonder if those constructs have political might backing them?

    (hint: It isn’t the free market)

    • There is very little in the US medical system that is free market. Only a vanishingly small amount – the self insured wealthy where lots of extras are thrown in at great price, and a little with high deductible plans coupled with health savings accounts.

      That said, the free market isn’t going to be nice to those with rare diseases. A drug for a rare disease is every bit as expensive to develop, test and approve. Only through indirect socialism where costs are shared at the drug company to more popular medications, cost sharing through insurance or direct socialism where the development costs are paid by the government will it be possible to have a reasonably priced drugs of this nature.

      That’s barring a drug company that is truly altruistic, and with Wall Street driven companies, I wouldn’t expect that to happen.

  2. 1. I’ve heard variants of the Moore/brothel story before. Still, maybe he hasn’t met Moore, but if a nearly 40-year-old accusation is credible, why not a 45-year-old rebuttal?

    Then again, I have come to the conclusion that Beverly Nelson has probably leveled a false accusation against Moore. I have come to doubt the accusation of the woman who claims he pinched her in his office in `91. And as a result, I have questions about Leigh Corfman’s story.

    2. I don’t think this drug is a dumb drug. I think of it as the first step to finding the cure for spinal muscular atrophy. Beating some of these diseases takes time and research. 50 years ago, what were the chances of a woman with breast cancer or a child with leukemia? I remember 25 years ago, HIV/AIDS was a death sentence. Now, not so much in both cases.

    But those cures and treatments start somewhere.

    3. Words fail me.

    • 2) One of the burdens of a free market is that at the start of a new product, often ONLY the very wealthy can afford it and even then there isn’t much of the product for the wealthy to even afford. But over time, costs come down and supply increases to the point that a product is merely taken for granted as being available easily for all.

      2a) This is an easy effect to see and accept in products like TVs or Cars or Houses…

      It’s less easy to accept when people’s lives are at stake…but it may be one of those painful things we HAVE to accept, knowing, that in the future, such products WILL be available to all. I’m afraid that artificially making them available to all will incentivize there never being any reduction in cost nor substantial increase in supply and any incentives for rapid advancement of the quality of a product are degraded as well.

      2b) I wonder, if we really had a free market, how soon this particular product would be much lower in price and much more readily available in supply (and in increased quality)? 15 years? 20? 50?

  3. Just a note on Nusinersen. I haven’t looked into them specifically for this argument, I’ve just worked in industries that are generally associated with high start-up costs and I know that pharmaceuticals are one of them. When developing cutting-edge technology without a pre-existing production ecosystem and/or market, it’s common practice to charge a premium rate when a product is first released then slowly drop the price over time. That initial high price is often necessary to fund the corporate and equipment costs of ramping up production that will eventually allow them to lower prices (like Tesla) or for sustaining the company while the market for their product develops (like early internet providers –

    In terms of ethics, it’s the only way to provide a good/service with a high development cost, so yeah it sucks that the price is obscene and that some kids won’t be able to get it in the short term but it’s likely the only way to guarantee the wide availability of the drug in the long term.

    That, of course, assumes that the drug was expensive to develop and/or that the production ecosystem follows the rules of the economy of scale and that it’s in the early stages of that scale, and that the company doesn’t plan on or can’t execute the price advantage of a monopoly.

    • My (now ex-) father-in-law was a pharmaceutical rep for his entire career. The trips to Hawaii, Italy, the Caribbean… The tote bags, computers, gadgets, the un-ending “won” crap that filled his garage and which he pawned off on his kids (I know. I was one)… It unnerved me no end. All those fancy trips, trinkets, and junk came at a price. That price was paid by insurance companies, the government, and every other dumb schmuck who lined up to pay for their overpriced prescriptions.

      • 1 in 3 of the much maligned “1%” are in the medical or pharmaceutical fields, and the share is growing rapidly year by year.

        If the industry doesn’t address this themselves, the government will “fix” it for them. Being a pro free market guy, I don’t want to see even more government meddling but I think it is inevitable. We’re too close already, with no slowing of medical costs.

        • I suppose it is, Tex. But I guess I try to reconcile successful salesmanship against the self-employed husband and his stay at home wife with their cancer riddled child and ask myself where profit and altruism come into play. At what point do we value human health and well being above capitalism and the drive to make a profit.

          Do pharmaceutical companies have a right to make a profit? Yes, I suppose they do. Their years of research and expense should be compensated – but by what percentage, by whom and how? My wallet? My insurance company? My father-in-law’s trip to the south of France?

          And are we comfortable, as a nation, with pharmaceutical companies profiting off of a cancer riddled child? Maybe we are. And if we are, we better suck it up and admit that that is who we are.

          I don’t have answers and much of my rant is just my thinking out loud.

          I can’t help my mushy heart feeling for those who are caught in between.

          • I’m not with kids dying of cancer today and for the next few years so that little to no kids die of cancer for the rest of them. I’m not okay with it, but I’m 100% willing to accept it The number of kids saved will vastly outweigh the number that die.

            Of course, I’d also be up for some kind of government program that puts a finger or foot on the economics of scale for proven effective life-saving drugs. I don’t think many taxpayers would bat an eye at dumping a few million into tax-free interest-free loans so that we can get cheap medicine out there.

            In any case, I’m against using the dying kid argument to kill the economic engine that develops these cures (i.e. force them to sell at lower prices than what the market demands).

            • I’m not [okay] with kids dying of cancer today and for the next few years so that little to no kids die of cancer for the rest of them.

            • Not force them to sell at a lower price than what they’ve spent to develop the drug. But, as a mother, there’s something offensive about the idea that my child’s illness drives an industry to develop a drug, perhaps a life saving drug, that said company shills on a scale that sends a salesman to an all expense paid trip to Europe while I have to decide between paying rent or the cost of drug itself.

              What the market demands…. That’s where we have to decide who we are: Are we, as a community, a people, a country, an economy, willing to decide what price are we willing to pay for life? We often discuss the conflicting views surrounding abortion on this blog. When does that same child, saved from abortion, who is now perhaps an adult, become no longer viable and worth caring for? Does their welfare really come down to what the market demands?

              • ”as a mother, there’s something offensive about the idea that my child’s illness drives an industry to develop a drug, perhaps a life saving drug, that said company shills on a scale that sends a salesman to an all expense paid trip to Europe while I have to decide between paying rent or the cost of drug itself.”

                Well put! As a human being, that’s some serious incongruence.

              • So what then? Force them to sell at the cost it took them to develop the drug? Even if you could determine that number (and I promise you, it is no simple feat) what profit would the company make? None. You’d have killed the very engine that develops the drug. How about allowing them to a little bit of profit? Well you’ve already killed a large part of the incentive (i.e. large profit) it takes to create these drugs but even if they did it anyway you’d be stepping into the realm of price control which no government in the history of man has ever done well.

                I can’t tell you how thankful I am that there’s an industry that drives drug development. It would be nice if every biochemist, engineer, and scientist were like Jonas Salk and Albert Sabi but those are rare men indeed. The pursuit of profit has driven nearly every great technological and humanitarian innovation in the last two hundred years. And for my own sake and that of humanity’s I would gladly justify premium prices today so that the engine of progress stays alive and gives the next generation a shot at new cures and cheaper cures.

                Anything else is to throw ourselves to the mercy of human goodness. It would be nice if that were viable, but like communism and hippy communes, it only works on paper.

      • I’d be curious to know what era and market niche your father in law worked. I also have an ex-father in law who was a pharmaceutical rep for most of his career. He switched industries in the 90s because all the ethics regulations that were passed against wining-dining-and-buying doctors onto your drug product. It basically made it impossible for his high profile drug company to get doctors to prescribe the brand name medication over generics – they couldn’t justify the price difference to their clients without the added motivation of the indirect kickbacks. Side note: if that sounds like an unethical way to sell drugs it is! My ex-father in law ended up in second world prison for some unrelated activities.

        • Yes, this was the mid 90’s. Andy my father-in-law would brag about the trips, the gifts, the perks…. and every time, all I could think was “there’s a person suffering, a family worried, on the other end of what you’re selling. But you enjoy yourself in Hawaii now.”

    • I know all that, RPE, but there are high drug prices and unconscionable prices that make no sense. Why not just charge the first user millions of dollars and be done with it? A six figure cost for a magic bullet cure is defensible. This is ridiculous.

      • The first user might not be willing to able to pay millions of dollars. Especially if they’re willing to bet that the next millionaire over will pay the millions and he can get it vastly cheaper and still save/extend the life of his kid. More likely though, the rate at which this affliction strikes isn’t high enough to guarantee a millionaire family waiting in the wings at the time of release.

        I know you likely thought of all of that while writing but you didn’t touch on it and seems like a fair counterpoint in the absence of development and production data.

      • I think there is another ethical issue that was not brought out in the article or the discussion thus far and that is that there should be essentially no babies that need treatment in the first place. SMA is an autosomal recessive genetic illness. Both parents must carry the bad gene and if they do there is a 25% change that any child they conceive will have the illness. There is testing available to determine carrier status and in utero testing to determine if a fetus will have SMA. There would still actually be an extremely small number of babies born with the illness because testing is not 100% perfect and there are spontaneous mutations.

        If a couple finds that they are both carriers, they have a number of options. Don’t have children at all or adopt. My children are adopted so I am prejudiced towards that. They could use artificial insemination with sperm from a non-carrier male. They could utilize in vitro fertilization using a donor egg and the husband’s sperm. They could take the odds that there is a 75% chance that they won’t have an affected child and when she becomes pregnant use one of the in utero techniques to determine if the fetus is affected and obtain an abortion if that is the case. Lastly, they could just take their chances. Given the devastating nature of this illness how far should society go in taking measures to combat it, such as mandatory testing?

  4. A propos of almost nothing: I think I told this story here before, right out of law school, I went to work for a judge. The other clerk in the office was a year ahead of me in law school. He had/has spinal muscular atrophy. Wheel-chair-bound, on a ventilator, could speak in a garbled way, and could operate a cursor by moving his head, with a small pad he could move with his thumb to “click” on things. He completed law school and passed the bar. I don’t know how or if this drug would have helped him, but some with spinal muscular atrophy do survive.

    On a related point, the first jury trial he clerked was a personal injury case. Bicyclist was drunk at 9 a.m. and ran into the rear wheel well of a school bus. Horrendous injuries. Large offer of settlement ($80,000.00) before the trial. Juror passed out during the expert testimony about sucking fluids out of the Plaintiff’s lungs after the accident, and 18 14-year old passengers called in to testify about what they saw (a challenge to maintaining decorum if there ever was one).. And, Plaintiff’s attorney made a pre-trial motion to exclude the clerk from the courtroom, as he feared my co-clerk’s presence would reflect poorly on his client, who was claiming an inability to work.

    The Judge denied with righteous indignation. Plaintiff got zeroed out, finding the bus driver did not do anything wrong. Plaintiff brought new trial motion, which included his previous motion to remove the clerk as error. Judge denied it and reported the lawyer to the Board of Professional Responsibility. The Board “split the baby” and said that the pre-trial motion was not unethical, but the lawyer should have known better to re-raise the issue post-trial. A private reprimand was ordered. I believe the Plaintiff’s attorney appealed. The case went to the Supreme Court, where the discipline was confirmed (now being public, of course).

    The punch-line: the clerk was invited to the arguments before the Supreme Court, but he could not get in because it was not wheel-chair accessible.


    • I wonder if enough usage of this drug, even at its exorbitant cost per dose (much less the full run), can impact other age ranges or uses? The sad part of some of these miracle drugs and treatments is that they have to reach a critical mass of patients to find all the good and bad stuff. Like the weird side effects that didn’t happen in control groups but are found once it’s out in ‘gen pop.’ But there’s also the weird good stuff that’s found when they can zero in on why it’s even better for some patients than others. Like what we now know about certain breast cancers- they not only stage them, they get the genetic markers ASAP because some treatments are more effective. And we wouldn’t know if not for the many years of figuring it out. Nusinersen will take forever to make an impact at those prices. Breast cancer stuff never cost that much and has a much larger patient cohort.

      • After surgery to repair a deviated septum & nasal bone spur ~ 38 years ago (I led with my schnoz when I boxed) I realized the blessing that was demerol.

        Post-procedure, I was in a lot of discomfort & the nurse gave me a demerol hypo. Whoa Nellie! It was a warm, soothing “ripple” from my core that spread throughout, a wave washing to every extremity with ethereal calm.

        I can see why they don’t lay that stuff on too thickly, or too long after surgery; it appears it could be rather habit-forming.

        Reminds me of a sequence in “Red Heat.”

        Commander Lou Donnelly (the late, great Peter Boyle): “Since I figure cops are cops the world over, how do you Soviets deal with all the tension and stress?”

        Arnold Schwarzenegger’s Ivan Danko: “Vodka!”

  5. I’m going to do a spam-check…

    Yup…I found six inexplicably grabbed as spam. I eliminated the repeats, and they are posted. Just e-mail me if this happens. I have no clue why it does, but you’re not the first.

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