- Field notes
This distracted globe.
The last Fellows meeting is scarcely a month past as I write these words, though it seems rather longer. Pace of life, perhaps, or maybe it's related to our having gathered in Washington, a city that for me carries a touch of the unreal. The heart of the meeting—a panel presentation with the title "Are We Ready for the Flu Pandemic?"—was certainly substantial enough, the sort of theme fully able to concentrate the mind (there being nothing for doing so like a personal prospect of death, as we're told). A hot topic coupled with extremely effective presenters—savvy, highly placed Beltway insiders, all knowledgeable about and sympathetic to bioethics, with varied close-up sight lines on congressional and administration responses to H5N1 and company—and an arresting take-home message ("Decidedly Not"), generated a keen audience, who asked intense, probing questions.
Here's what struck me hardest in the picture the panel sketched out: our national tardiness reflects, in part, ongoing dickering between pharmaceutical companies and the government over the size of subsidies and indemnities to be guaranteed before the corporations are willing to knock out job-sized lots of vaccines and antivirals. One way of luring corporations into this business, according to one of our Beltway insiders, would be to give corporations an extra year of market exclusivity for their ten top selling drugs, by means of a wild card patent extension. The price tag: around $30 billion. A Fellow adopting the pose of a simple country lawyer (in actuality one Alan Meisel) had the temerity to pose an "Emperor's New Clothes" sort of question: why are we even talking about massive subsidies to private industry, when a "Manhattan Project" style public program could likely do the job for about $2 billion, a mere fifteenth of the cost?
Asking a question like this of those who for one reason or another are more or less locked in to the current dispensation tends to get the same kind of reaction as asking why we don't take advantage of the hundreds of billions of dollars in economies that would be afforded by shifting to a single payer universal coverage health care system. Some folks have the grace to look rueful. Others look at the questioner as if bringing the matter up is rather rude. Ruefulness was the order of the day among our superb and very graceful panelists. Yet in the absence of better answers to questions like Meisel's, the worry is that we pay hefty premiums, in human lives and human suffering, as well as in dollars, not for the market's pragmatic benefits, the efficiency and quality for which the private sector is so celebrated, but for something else. Spoils for a triumphant ideology, perhaps?
Good ethics, as Tom Murray reminded us in concluding the session, depends on good facts. As I walked out into the streets of the nation's capitol reflecting on this sage advice, I was grateful to have had important facts about the possible pandemic so thoughtfully laid out. Yet it hit me harder than usual that good ethics can depend, too, on noting which facts make up states of affairs that are tolerably independent of anyone's desires or schemes, and which reflect fantasies someone has been able to make real. [End Page c1]
Fellow of The Hastings Center