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The Common Good

A recent episode of Boston Legal raises an interesting question, where to draw the line between individual rights and the common good. The choice of alzheimer's disease and experimental drugs is a good one. If you can get by a bit of silliness I think the program did a good job of highlighting the issues. I come down squarely on the side of the common good, unless of course I'm the individual.


 

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Common Good. And I would get my grandparent into the next clinical trial it if came down to it. I think her argument was stronger.

"I come down squarely on the side of the common good, unless of course I'm the individual."

That's very well phrased, Norm. It captures well the crux of this particular issue, and so many others.

Boston Legal, as it has so many times before, did a great job presenting both sides of a debate. It is a pity that this was its last episode. A great loss for television viewers; at best a draw for television.

Her argument was good based on the way things work right now. But there's no reason that the way things are right now can't change.

I had some friends with Junior Rheumatoid Arthritis, a horrible destructive disease. In one it attacked the cartilage in his knees and neck, and in the other it attacked her eyes, making her legally blind.

They were both fortunate enough to get into separate clinical trials for a drug that successfully treated JRA, without any side effects. Unfortunately, both trials were shut down prematurely because the company ran out of money. There were other trials for JRA going on that they qualified for, but they all had bad side effects, from turning teeth black to prematurely starting puberty.

The friend with the knee and neck problems was lucky, he outgrew his JRA before the symptoms kicked back in once he stopped taking the drug, but my other friend was not so lucky. She went on a couple of those other clinical trials, and one of them caused her to start puberty early, closing her growth plates.

What options are available to people when the patented drug they want to take is not undergoing clinical trials? If a company decides to not move forward with testing of the drug, and it's not in a highly profitable market, will they ever have access?

Perhaps we need to rethink how clinical trials work. Perhaps we need to come up with a system where the federal government shares the burden of clinical trials and then gets to share in the profits (or lower the price).

It is unconscionable to me that we allow capitalism to trump the rights of individuals to obtain proper medical treatment for terminal or highly destructive diseases.

Or mass surveillance where even if personal privacy is trampled over, the common good is better taken care of.

The young lady's concern is that if the standard is set low for one person who consented to it, it therefore means de facto that the standard will be set low for everyone else who did not. That may be the case now, but that need not always be the case.

That is the case now because a court (or any government agency) cannot make one law for one man and a different law for another. The paint with broad brushes.

But absent government intervention the dichotomy of individual rights vs common good collapses.

Like the lady said, 'It is not about finding cures as much as it is about finding markets, selling.' A drug company selling untested drugs would find desperate and willing people with incurable diseases as their market. Desperate but unwilling people will not be part of that market of course.

Well tested drugs will be sold to less desperate people and wiling people. No single standard will be imposed on everyone against their will. Everyone's individual rights get safeguarded, the common good takes care of itself. The real problem is letting the government make these decisions.

"I come down squarely on the side of the common good, unless of course I'm the individual."

And therein lies the paradox of the modern progressive.

From the schmuck with the blinking tie: "a constitutional right to bear arms"? As in the 2nd Amendment?

I understand a certain degree of melodrama is necessary to keep things interesting, but this clip was just bizzaro. If this is where Americans are getting their knowledge of law, it is no wonder things are so messed up.

the problem can be addressed in the following way -

Not all drugs or treatment strategies can be reduced to a simple algorithm to prove or disprove its effectiveness.

the factors to be considered are these: 1. the response rate 2. the natural disease course 3. the adverse effects

IF, in a nonrandomized trial, a drug demonstrates a dramatic response rate for a disease whose natural disease course is almost certainly fatal in a very short time without adverse effects that impact an individual's remaining quality of life THEN i would argue that there is no need for a randomized clinical trial.

IF, on the other hand, a drug demonstrates a marginal but possibly real response rate for a disease whose natural disease course may or may not be fatal over an undetermined period of time (even if it eventually becomes uniformly fatal) and is accompanied by adverse effects that impact an individual's quality of life THEN there are grounds for a randomized clinical trial. These are the two extremes and certainly there are cases that fall in between.

Unfortunately, the FDA has almost always taken the second scenario and applied it to all drugs in all situations and therein lies the source of this conflict.

So, while i commend Boston Legal for raising the issue with all its verbal hyperbole , the issue is not black or white - in some cases a randomized trial is essential; in some cases it is superfluous. this issue deserves clarification and a greater understanding at the very least at the level i have described above - by considering the above 3 factors associated with any drug in early phae studies, there is no reason why a nuanced solution cannot be achieved that satisfies the drug companies, the legal system, the individual and the common good.

The problem can be addressed in the following way -

Not all drugs or treatment strategies can be reduced to a simple algorithm to prove or disprove its effectiveness.

the factors to be considered are these: 1. the response rate 2. the natural disease course 3. the adverse effects

IF, in a nonrandomized trial, a drug demonstrates a dramatic response rate for a disease whose natural disease course is almost certainly fatal in a very short time and the drug is without any adverse effects that impact an individual's remaining quality of life THEN i would argue that there is no need for a randomized clinical trial.

IF, on the other hand, a drug demonstrates a marginal but possibly real response rate for a disease whose natural disease course may or may not be fatal over an undetermined period of time (even if it eventually becomes uniformly fatal) and is accompanied by adverse effects that impact an individual's quality of life THEN there are grounds for a randomized clinical trial. These are the two extremes and certainly there are cases that fall in between.

Unfortunately, the FDA has almost always taken the second scenario and applied it to all drugs in all situations and therein lies the source of this conflict.

So, while i commend Boston Legal for raising the issue with all its verbal hyperbole , the issue is not black or white - in some cases a randomized trial is essential; in some cases it is superfluous. this issue deserves clarification and a greater understanding at the very least at the level i have described above - by considering the above 3 factors associated with any drug in early phase studies, there is no reason why a nuanced solution cannot be achieved that satisfies the drug companies, the legal system, the individual and the common good.

What?!? This was the last episode of Boston Legal? I had no idea! It's one of my favorites!

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