value is what we make it

Episode 3 / Season 13 of WNYC’s Radiolab asks, “What is the value of human life?” in a story titled, Worth.

This article questions how much life is actually worth to us. On the street, they put the question to passers-by in the form of, “What would one year of healthy, productive life be worth to you?”

Answers ranged from the ridiculously small ($5 – surely life is worth more than a Venti Frappacuinno at Starbucks) to the absurdly high ($10,000,000 – perhaps it would we worth that to someone with a net worth in the billions, but probably not for the average person.

Is a year worth the salary you make in a year? Apparently non-working spouses (or young children) are worth zero.

Is it the same value for every person? Is a year of my life worth as much as that of a fortune 500 CEO’s. The President? A Nobel Prize winner? A crack dealer?

These questions led into a story about the high price of human medicine, where a single pill, taken once or more a day, can cost over $100 – and some advanced ‘personalized’ cancer treatments can be tens of thousands of dollars and buy no more than a month of extended life.

If these prices are socialized, then all of society pays them. So, what if everyone in your insurance plan needed intensive chemotherapy and radiation treatment this year? Where would the money come from? Would the same money be spent if the individual was presented the bill as opposed to an insurance company – or would they simply decline treatment?

(For the moment, let’s assume that you and your insurance company would actually be billed the same amount, which itself is unlikely.)

Where do these outrageous prices for medicine come from? Mostly, they stem from the need to cover the expenses of R&D and clinical trials (for both successful and unsuccessful meds) paid in their discovery. We pay these high prices because developing new therapies is hard. And testing them in the lab and in clinical trials is expensive (http://www.manhattan-institute.org/html/fda_05.htm).

So, in a way, we are already placing a pretty high value on our own lives by making our insurance companies pay for these expenses.

Which brings me to another article published this week by John Russell of the Indianapolis Star, Pets at Risk. Some good questions were raised, but more prominently, a number of blatantly irresponsible statements and suggestions were made.

The article begins by identifying a number of animals that all took a new, chewable flea and heartworm medication and are now dead.

“Their owners wonder if the drug, known as Trifexis, was the cause. “

The author of the article, however, has no doubt.

“Yet, in the first examination by a major news organization of one of the fastest-growing segments of the pharmaceutical industry, The Star found an industry far different from the human drug market, one with higher risk of unforeseen side effects, a legal arena that offers little protection to pet owners and marketing tactics that have been eliminated from the human drug market.”

The article continues to point to the value of the drug market in animals as a motivation for deception and implies that veterinarians are complicit in pushing these drugs for the pharmaceutical makers without providing any evidence of misconduct.

Meanwhile, one pet owner’s assessment of a causal connection between the medication and pet deaths is given undue weight, presumably because he is a human surgeon. “Essentially, with what I do, you put two and two together and it usually means four… I immediately knew … there was probably a correlation.”

Presumably he knew better than to say that there was any causation, but again, the article’s author does not shy from that assessment.

One argument made in the article is that veterinary meds are not held to the same standards as those that go into humans. Russell explains, “[t]he drug-development process for pet medicines is far shorter than for human drugs, which cuts costs but increases the health risks to the animals.”

From the same article: “Trifexis was tested on 751 dogs in 15 trials, according to Elanco’s drug application filed with the FDA. That’s a far smaller sample than used for typical human drugs.”

In order to keep prices down in veterinary medicine, it is true that trials are not as extensive. However, since this would come directly out of client’s pockets rather than an insurance company, it’s not much of a question to ask how many clients would pay for a $10,000 / mo. drug for their animals.

In addition to assuming that society literally values its pets just as much as it values humans, Russell then goes on the attack. He is quick to suggest a conspiracy between drug developers and veterinarians by again pointing to differences in policies concerning the interaction of veterinarians and pharma. Then, to further illustrate the cold-hearted nature of drug companies he adds,

And when animals die, the companies don’t have to shell out big legal settlements. Pet owners usually can recover only the replacement cost of the animal — often no more than $100…While drug companies have paid billions of dollars to settle complaints about human drugs, they sometimes resolve consumer complaints about pet medicines with polite letters and payments not even large enough to cover the cost of veterinary treatment.

The American Veterinary Medical Association responds,

-First to the article itself:

On behalf of the veterinary profession, the American Veterinary Medical Association not only takes exception to these implications, we are offended by them. Veterinarians are, first and foremost, committed to promoting, preserving and protecting the health of our pets.

-Then, more specifically,to the economic issue:

Allowing noneconomic damages could provide a financial windfall for a few pet owners and their lawyers, but they would also raise the cost of veterinary care for all pet owners….licensing bodies have ample authority to regulate the rare case of substandard care without making the cost of care unaffordable to many pet owners.

I found the Star’s article offensive as well – even though I am not a veterinarian. But, in sticking to the theme, I’ll ignore the accusations of conspiracy and stick to the question of worth.

And to my little dog, Trouble, $12M

Although many people would consider their pets no different in emotional and economic value than they would themselves, I doubt that this is a majority.

In general, the approval process for veterinary medicine looks like this:

Although I couldn’t find numbers (in my brief search) for animal health, I did find this graph for the price of developing drugs for the human market. I thought I’d finish with that.