Week 1 Post 1-Buying and Selling of Reproductive Services

 Current Challenges to Healthcare Finance

-In 2001 the drug GLEEVEC was approved by the FDA, and it was a drug that helped with leukemia by created a specific chemical compound that targeted the cancer; it was considered a designer drug

     -The drug had a specific chemical compound that disrupted the reproductive systems of misshapen white blood cells that would've crowded out healthy ones

-In 2004 a different cancer drug, Avastin, was created, which stopped cancer cells from spreading by restricting their access to blood vessels, and was the first biomedical medicine because the treatment was grown in live cells

-Another biomedical science treatment, which has been used to treat cancer is taking out a patient's T-cells, modifying them to identify cancer cells and put them back in the patient 

-The pharma index, the accumulation of the biggest pharmaceuticals companies that trade stock, has been fairly stagnant from 1994 to when the course was published, and the Biotech industry has had a massive amount of growth. In the 1990 the index seemed to be on an upward slope, but flattened out and  even regressed shortly after.

    -This growth is partially caused because biotech companies tend to focus on one specific thing, while pharmaceutical companies place interest in many

    -The index for the biomedical industry really took off on April 14th, 2003, which was when the human genome project was announced 

-Even  though there have been many breakthroughs in the biotech industry there has been a decrease in funding, mostly federal, for political reasons, but also in the private sector because there has been a belief that research is a risky investment, especially pre-clinical research, because it is very costly, takes a lot of time, and has a low probability of success 

-Because there has been such advancement in the biotech field, and people are getting smarter they are creating more and more complicated projects, which is making the value of output to input go down, making the industry seem less efficient 

    -For many companies because of this lack of funding their source of funding drives their scientific agenda 

-Many investors do not invest because of risk, but there is an expected high return rate, such as investing in more companies there will be a high return rate

The Basics of Reproductive Technology

-Artificial insemination works by inserting a donor sperm up the cervix to the uterus to maximize the chances of fertilization, and is most commonly used by single women and women with partners unable to reproduce

    -This procedure can be vary expensive ranging from 800-1500 per vial, and there are very few ethical problems that have been raised with it 

- Egg freezing is when unfertilized oocyte is removed from a uterus and is frozen to preserve the genetic material and is utilized by people who do not want to be pregnant at the time but may have circumstances in the future where they would like to but are unable

    -Another part of egg freezing is embryo freezing where an embryo, which is an egg that has been fertilized and is starting to develop an organism, is frozen for insertion

   -The cost of egg freezing is annual 

-In vitro fertilization (IVF) is when eggs are simulated to be created with chemical compounds and are removed from a uterus and placed in a petri dish and are combined with a sperm, in a process called natural insemination. The cells are able to grow until they form a blastocyst and reach pluripotency and then they must be put in the host uterus to grow further

    -The patients are typically diagnosed as infertile, or patients how do not have fallopian tubes, or same sex couples, and IVF is incredibly expensive, costing a minimum of 10,000 traditionally

   -The harvested eggs can be used by the person they came from or another person, and embryos will contain the genetic information of the person who the eggs came from, not the carrier

    -Success is depend on age, with younger patients being more successful, but success rate vary clinic by clinic and the demographic that is treated 

    -The high costs of IVF can force some people to have multiple embryos inserted at once, which can result in a multiple pregnancy which is dangerous and more costly

-Gestational surrogacy, is when a person carries an embryo to term, but the genetic material does not come from them and the baby will be given over to others, and has different legality in different states

-In pre-implantation genetic screening(PGS) a lab grown embryo has the placental tissue removed and looked at to see if there is enough chromosomal content to create a person, which can be helpful to parents who have extra or incorrect chromosomal placement which does not effect them but can result in repeated miscarriages, or terrible genetic diseases 

    -The application of these identitive technologies ahs gone so far that people have requested to decide the gender of their child 

-Blastocysts are when the cell has divided up to 80-100 and have become differentiated, meaning they have assigned purpose   

-Some states have mandatory fertility coverage with health insurance, but many do not, leaving people who cannot pay for the expensive surgeries and upkeep behind. A mandatory coverage of fertility with insurance would also create more regulation for clinics

-There is a small but burgeoning market for embryo adoption, where people make embryos and cell them to others, which is done for profit

    -In the past it was legal to buy sperm and an egg uncombined, but this knew development, where many genetically similar siblings were being created by clinics, was questioned and considered unethical, but is legal

-The language around the market for sperm and egg donation is very different, with the language around sperm donation being job-like and professional, whereas egg donation is framed as a gift (bank v. agency)

    -People who donate eggs are also subject to different line of questioning, as sperm donors are expected to donate to make money, but egg donors will be rejected if that is their line of reasoning, again showing the standards of femininity put onto egg donors, where women are expected to be generous and good-natured 

-There has not been long term data on the effects of egg donation on the donators, which has led some to say they cannot give informed consent, because the long term effects are unknown

Ethics of Reproductive Technology

-There are many ethical arguments about the selling of particular goods, one of which is corruption of the value of certain objects if they are for sale

    -The belief is that the good or the producer of the good inherently becomes dehumanized if the good or service is sold. For example, many believe that if organs are sold, humans will be seen as a product and not people

    -Similar concerns have been brought up about surrogacy

    -Two subcategories of this argument are "consequentialist" which says the morality of the action depends solely on the consequences of that action and prioritizes good, and  "intrinsic" which says that despite what the actual outcome is and what public opinion is the wrongfulness of an action occurs right as the action occurs, without having to look the outcomes

    -Non-consequentialists argue that even if an action has good outcomes it does not necessarily have moral value, especially if the outcome restricts someone else, which is a philosophy called deontology

    -The other side of intrinsic corruption is contingent corruption, which says the morality of an action depends on what happens in the  real world

    -To argue that the selling of surrogacy has intrinsic corruption, their has to be a claim made about how a society's values, or about the essence of the product 

-Another ethical objection to surrogacy is the idea of crowding out, which suggests that, in contrast to the typical economic model, allowing payment for goods can change a social meaning to a good, and make people less likely to supply the good

-Another ethical concern is that if there is a market for a certain good, coercion will occur, as poorer people will be forced to sell that good, eggs in this case, because they have no reasonable economic alternative 

    -How the argument about coercion is framed for the market for eggs, is that if a person has no reasonable alternative than doing an action, and the proposer of the action is not in a position to morally make the proposition

-Exploitation, an argument made against selling eggs, is that a person is being taken advantage of for the benefit of someone else, or for the harm of themselves. People who believe this say that egg selling exploits the seller because the buyer net profits, is ultimately harmed or treated unfairly, and by transaction, as it can force poorer sellers to sell at a lower price given by the buyer

-Two ways of looking at the transaction are Ex Anti, what did the sellers and buyers expect before the transaction, and Ex Post what actually occurred

-In harmful exploitation, the seller is hurt and the buyer benefits, but in mutually advantageous exploitation, both the buyer and seller benefit, but the transaction price is unfair, on a moralized baseline, which is weighing what the patient ought to receive versus what they do.

-Undue inducement is when a seller is offered "too much" and it is too good to refuse, which in effects limits the sellers autonomy to make a choice 

-The argument of unfair distribution against selling eggs and surrogacy, is that only the rich will be able to buy them, and it is sort of the flip side of the coercion and undue inducement arguments

    -Making the service of surrogacy and the good eggs be a commodity would make some people who would donate these things expect payment, so he supply could increase but the distribution of the service could change

-The buying and selling of human goods could contribute to eugenics, where people seek out goods from people they deem as "better" 

    -In the 70s a sperm bank called The Repository for Germinal Choice, where only Nobel Prize winners could donate, and only similarly accomplished women could utilize, to create more "gifted children". The only person who donated was incredibly racist and many other members were too old 

    -Currently the sperm market already participates in a form of genetics, not only screening out people with bad genetic diseases, but also catering to the positive genetics a person might have

          -There is a marketization of whiteness in sperm banks, preferring archetypical white features, like blond hair and blue eyes, which "suggests" that to society these traits have more value

-While there are many objections to the selling of eggs/surrogacy, instead of prohibition, what regulations can be made to fix some of these objections? 

     -One way to fix the objection of unfair distribution, and unjust inducement is to create price floors and ceilings 

     -Another way to fix unfair distribution, along with exploitation and coercion, is to have the government pre-qualify a certain people 

     -To fix the eugenics objection the government could limit access to donor information