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Discussion in 'Pre-Medical - MD' started by klampster23, Feb 28, 2007.
If you had exactly 100 pills that could cure cancer, how would you decide who to give them to?
Simple. The 100 highest bidders.
And now for a more serious answer: You give 1 pill to a scientist who can make more pills. Not a reasonable answer? Well that wasn't a reasonable question to begin with
I agree.....the 90 highest bidders, 1 for someone who can make more, and the rest for myself, my daughter, etc.
Those point-blank ethical questions designed to make you think on your feet always scared me. At the school that accepted me, they asked a few ethical questions, but they were honest, what-would-you-do questions.
I can see merit in asking questions like that, but sometimes they just make me wonder what the interviewers are trying to do.
The case of age (potential)
The case of usefulness to society (the cashier at McDonald's vs. a teacher)
The case of economic resources (who can offer more money)
The case of need (A mother/father of 3 vs. a single childless patient)
....Obviously, there is hardly a right answer since our judgments of who is useful, needed, and has the more potential can be mistaken, and these criteriae are subjective and overlapping with each other.
To answer your question, I don't know. I'm just offering some ground on which to base your answer.
Nice! I think this is partially what interviewers are looking for in asking such questions.
One thing I hate about ethical questions is that they involve criteria like this and make us decide whose life is more valuable. I hope I am never in a situation where I'm the less valuable life--ouch.
Welcome to clinical medicine. Let's hope you never have to triage.
In bioethics you will learn this isn't necessarily true. While it is a nice philosophy that every life is just as valuable, TECHNICALLY, not every life is, and that is why there are different categories for evaluation. Sometimes you have to make decisions like this (recent example: flu vaccine shortage, who should get the vaccine? What if you don't have enough for even a specific group? You HAVE TO decide in these cases...not just take the easy way out).
Saying you wouldn't give them to anyone and send them to a lab instead is taking the easy way out and you are avoiding answering the question. If these 100 pills have already been devised, it is presumable you don't need to send them to a lab, somebody already knows how to make them (they may just be incredibly expensive or time-consuming to design).
This is sometimes an issue in clinical trials... there may be a limited supply of study drug due to manufacturing limitations and the number of subjects that can be tested may be capped (the number needed to determine with pre-specified certainty that the drug is effective). Who gets to enroll in the trial?
You want to exclude those who can not give consent to participate, those who will not cooperate with the needed follow-up, and those who have contraindications to the treatment (for example, poor liver function might be a contraindication). After than, a lottery may be the most fair way to allocate a scarce resource among a group of people all of whom stand to benefit from it.
Otherwise, this question is trying to trick you into putting a higher value on some lives over others. Don't take the bait.
well i didn't say i couldn't do it. i just hate that we have to.
give one pill to scientists to determine the structure of the compound in the pill using NMR and IR (if there's more than one compound, you could use gc to determine that). you need very little of the compound to figure this out. then they can mass produce. if for some reason this doesn't work out, give the 99 remaining pills to the first 99 people that ask.
most pills have an expiration date. so unless you induce cancer in your daughter, yourself etc pretty quickly they might go bad before you need them if you even need them.
Tell them you'd have an application process:
The first step would be online explaining why you've always wanted this pill and what you've done to deserve it.
The second would be a series of essays and some fees just for fun. Also, other people will write letters saying that the patient does, indeed have cancer, and that he wants the pill more than anyone else with cancer.
Then you'd interview the patients.
Make them wait awhile and wonder if they get the pill or die of cancer.
Put them on an alternate list (in case someone offered the pill would opt for cancer)
Then the deserving people get the pill and the rest just waited around for a year and wasted all their time and money.
tell the people who want it to submit their GPA and MCAT scores.
All or none for me. If they won't let you produce more, just destroy them. It'll create more problems than there already were.
Give 10 pills to the doc who prescribes the most drugs from your company as free samples. Then make the rest of the pills inaccessible to uninsured people. Hang on to them for 17 years and complain about how much each pill costs in research. Then when somebody else replicates your pill, sue them. True, you will lose, but the time you kept it tied up in the courts mean that your competitor can't make money off of them in the meanwhile.
Now your pills decrease in price, and your competitors make five or six of your pills for every one you have. As supply increases, they get spread to enough people to find out that while they cure cancer, they also make you depressed. Somebody commits suicide after taking your pill, everybody gets sued, and the pills get pulled from the market. No more cure.
Wait, I'll call the doc from Boiler Room. Sell him 2,000 shares, cap him at first, but let him buy more if he wants. Then I'll ship him pixie sticks.
Do I get to give out free pens with my 100 pills? Catered meals?
It actually becomes sort of fun if you can shut off those pesky things called emotions.
I disagree with dropkick. These questions aren't designed to make you choose. That, actually, is the exact opposite of what these questions are intended for. To say one person is better or more deserving based on subjective criteria is the definition of unethical. Like lizzy said, don't take the bait.
I also wouldn't give some lame answer about "indentifying the compound and mass producing it". They probably hear that answer from every unprepared smuck that walks thru the door. It is a ethics question, not a problem-solving question.
As for my opinion... and don't get me wrong, I'm not saying this is a good answer, but it would be mine... When I go over informed consent/choice I would tell the patients about the scarcity. If people know about it, a good chunk would probably opt for the therapies that are available now unless they do have a wife/husband and 3 kids depending on them, or are a child with great potential. If we as doctors make the decision to withhold these pills, it will make people irrate. But if these cancer patients are in control, they'd actually probably act fair and rationally (at least more so than the normal population). Sure you'd get some greedy people, but you'll also get some altruistic people. I would guess about 75-80% of people over 70 years old would not take the pill. Pure speculation, but it puts the patients in control to make the decisions that affect their life. This could fail terribly, but I don't think I'm in any position to make these types of decisions. Just because I'm a doctor doesn't make me God...
As for a triage environment, that's completely different. You aren't judging people on their potential as a person or any redeeming characteristics. You judge people on the severity of their injury and likelihood of recovery. Those decisions are 100% medical, and I'd have no problem making those decisions. If the 100 cancer pills had contraindications then, sure, that would be taken into account (just like alcohol use prior to a liver transplant), but if no contraindications are listed then it has to be assumed all patients have equal chance of beating cancer with said pills, thus the medical consequences are the same across the board. Easy answer, doc has no say.
Good Lord. One day, the whole medical school admisision process is going implode, forming an absurdity singularity where random residents of Arkansas trailer parks will, in defiance of the laws of physics, find acceptance letters from Harvard Medical School in their mailboxes.
Here's a better question: Suppose it's 4:40PM and there is an admission sitting in the Emergency Department. The on-call team takes over at 5PM. Do you start working up the admission knowing that it may take you until 5:30 or 6PM to finish or do you blow it off and let the on-call team handle it?
Oh, I'd sell the pills to the highest bidder. That's the fairest, most non-judgemental way. This question is a no-brainer. Like when they ask you what historical figure you'd like to have dinner with and everybody says "Plato" or that urine-drinking idiot Ghandi.
The correct answer to that one is "Your mother."
I would. If you don't want a stupid answer, don't ask a stupid question. 100 pills to cure cancer. Pffft. If it's going to be reasonable, why not at least make it in the context of a clinical trial?
Maybe Dr Addison Shepard who is a Neomaternalpaediatricobgyninternalmedical surgeon on Grey's is also a oncologyresearchpharmacologist and she found the cure for cancer.
Unfortunaly she only had the supplies/cash to make 100 pills as the rest went down to the $8million clinic run by surgical residents and the guys delivering her back up supplies got injured in a ferry accident and had to have burr holes put in his skull by his boys and a plasticologist surgical resident who used to model undies for Victoria Secret!
?! Is that what you would do with the flu vaccine???
This is the best answer ever!
i'd incorporate, call myself a drug company, and wait to be bought out by private equity.
There's a difference between a vaccine and a cure.
Depends what kind of cancer we are talking about. There is no single disease - some cancers are worse than others, and there are multiple mutations, disease processes that can cause cancer so it is not likely a single pill could cure all cancers (realizing this should get you bonus points on such a question -- there will never be a single "cure for cancer"). But if we are hypothetically assuming that the same pill can cure something severe and untreatable versus mild and largely curable, then obviously you give the pill to those with the more severe disease -- that helps them more, and helps bring down healthcare costs more.
Exactly what I was gonna say...
Hitler had most of Germany thinking Hitler > Cushing. If a doc from Germany in the 1940s had a pill and thought like you, Hitler would get the cure (assuming he had cancer). Different people value different traits. We are doctors, not historians/philosophers. We are trained in medicine, and most doctors don't have the appropriate background to make such decisions. I'm sure most doctors think they could, but I doubt their capacity.
How many doctors were convinced that their research during the Holocaust was the right thing to do? Furthering science thru experimentation on an unequal race. . . They probably thought they were philosophers too.
And i never implied everyones opinion is equally valid. All i said was personal opinions of doctors are invalid when it comes to treating patients. You treat the ones with the best likelihood of survival, regardless of position in society. That's why people on death row are still valid organ transplant recipients.
At first, I think I'd rule out giving the pills to those who don't have cancer.
I'd conduct interviews for people who wanted them and give out all but 25 pills. Sell 20 of them to the highest bidder and save 5 just in case I or someone I care about gets cancer.
I disagree that all human life is equal. Granted we all have the benefit of the doubt and when looking at a human from the "potential" aspect of their lives, everyone's worth saving. But then there are plenty of people out there who are wasting their lives and will never live up to or even approach the idea of "potential"
36 year old cracked out guy with 5 kids from 5 moms, who thanks to family reinforcement, expects a government dole and thinks that the world owes hims something. He will never work an honest day in his life. Given the chance at that pill, he'd think that the world owes him that, too.
Anyone on these boards who happens to have goals in life and is working towards them, kids or no, bad family history or not.
Which would you rather have breathing?
I agree that with information some people might opt to go for the regular therapies, but how often do we run into terminal patients who want to die, but their families insist they be full codes and that they go thru every painfull treatment out there? Are we considering the impact of a selfish family upon an altruistic patient?
The observations I've made so far in my career are colored by the population that my hospital serves, but so far I haven't run across too many people who can calmly say, "Gee, I'm 35 and will die of cancer if I don't take this pill. I'm sure there are tons of other people out there more deserving than me."
Everyone thinks they are more deserving than everyone else.
Imagine, if you will, telling Timmy the 12 year old concert pianist prodigy that you gave the last 73 pills to a bunch of elderly people who could have turned them down based on their advanced age, but didn't. And now there's no more pills so Timmy will die, while grampa lives another two years and then has a stroke.
I appreciate your idealism, but I think that the real world is far from utopian.
As for playing God, I don't think wisely distributing scarce resources is playing God. If anything, it's being a good steward.
Wow- remember "Sophie's Choice"? Although a decision must be made, there is no definite right choice, and you must live forever with your decision. Very comforting thought. Like practicing medicine?
Me:I would eat all the pills myself to make myself super cancer-free.
Me: I'm not kidding
Interviewer: uh... ok, Interview over.
I doubt the financial aid office would pass the medical school admissions ethics test because i see a similarity between the 100 pills question and the 10 scholarships question. It seems like most schools offer more scholarships to people of color than non color. Wheres the freakin ethics there. Obviously interviewers from 30 years ago dident weed out the nonethical doctors.
These questions are just to make the interviewer feel special. These type of questions only rid the truley honest applicants out.
I sure hope you get someone to edit your PS.
Dawn of the Dead
Loaves and Fishes
The body of Mr. Dubois recedes into the shadows as the nurse turns down the lights. His family wants some time with him before he is taken wherever it is we take the bodies of those who finally exhaust our ability to reanimate them. Mr. Dubois did not go quickly or easily. His death has spanned months, if not years. The massive stroke which finally finished him off was just the last in a series of insults, all of which steadily whittled away at his intellect, his quality of life, but never the conviction of his family that he needed to be kept alive at all costs.
The details of Mr. Duboiss decline are familiar to anyone who has worked in an intensive care unit. Already in poor health from numerous chronic medical problems as well as mildly demented, he suffered a minor stroke and became bed-ridden. His wife, in poor health herself, was unable to transfer him from his bed to a bedside commode and his children eventually moved him to a nursing home where, with the exception of dialysis three times a week, he spent his days laying in his own urine. Over the course of a year he made several visits to the ICU where he was treated for pneumonia and sepsis, urinary tract infection and sepsis, sacral decubitus ulcers and sepsis, and finally a COPD exacerbation with pneumonia and sepsis. This lead to the final, massive stroke which should have finished him off except that after years of neglect, his family was still not ready to let him go.
They were perfectly willing to park him in a nursing home, you understand, as long as they didnt have to think about him. Im sure they visited even if the visits eventually tapered off to a hurried fifteen minutes every other week, visits more to demonstrate that they still cared than to look after Mr. Dubois who lay in his bed literally rotting away both mentally and physically.
At the end the family didnt want Mr. Dubois to suffer, at least not while they were around. Im sure they didnt lose sleep over the suffering he endured as an immobile piece of bodily-fluid producing meat in his fly-blown nursing home. But in the hospital, with the doctor and skilled ICU nurses it was all sanctimony and reverence.
The contracted, slack-jawed body of Mr. Dubois continued its leisurely spiral towards death as we used every expensive weapon in our arsenal and spent tens of thousands of somebody elses dollars in our absolutely inexplicable desire to play along with the familys delusions.
The familys delusions, like most, grew in isolation of the basic facts. I suppose if his family had taken care of him at their home as was the case for almost all of human history the story might be different. If they were the ones cleaning his bowel movements, spooning soft food into his mouth, or living with the rotten smell of ulcerating bed sores, one of which had eroded down to his sacral bones, they might have been relieved at his death, both for their own sake and his.
Nor did they give a thought to the cost of his many hospital stays, the total amount of which is almost impossible to calculate. Somebody else will pay, they always do. Hes paid taxes his whole life, goes the mantra, so let Medicare handle it despite the fact that one week in the ICU probably ate Mr. Duboiss entire lifetime contribution to the system.
A day in the ICU costs several thousand dollars with only a minimal level of care. Then there are the many paid specialists continually consulted to tell us what we already know, namely that Mr. Dubois is dying. The nephrologists shakes his head sorrowfully over his kidneys. The cardiologist writes notes and orders expensive studies which reveal that his heart is bad. The gastroenterologist fails to discover the source of his frequent melanotic stools and the hematologist advises that even though his leukemia is going to kill him in a few weeks (guaranteed) we should go ahead and transfuse four units.
The vascular surgeon, the only realist in the bunch, when consulted for a possible repair of Mr. Duboiss dangerously bulging abdominal aortic aneurysm says, Are you ****ing kidding me?
Too bad he cant write that in his consult note. The dry precision of medical prose gives the illusion that we are in control of Mr. Dubois and could turn him around with a little coordination between the medical specialties. The family certainly buys into this notion. Arent all of his medical problems being managed? Dont doctors have all the answers with their extensive education and big words? Surely all of those monitors, pumps, and flashing lights must be doing something. Were not asking for loaves and fishes here, doc. Just keep his heart beating.
So thats what we do. In the end all we are really doing is giving the house staff valuable experience running ACLS codes. We get a carotid pulse back and beam with pleasure at the good thing we have done despite the fact that it is taking three different pressors to keep his blood pressure compatible with life and to remove any one of them will be the end of Mr. Dubois. What weve really done is paint ourselves into a corner. He is never coming off the pressors. In about a day, if he lives that long, Mr. Duboiss toes and fingers are going to start rotting off.
Perhaps then we can withdraw support, if its all right with the family that is.
to 100 expert researchers who specialize in drug amplification.
I'd give them to anyone who doesn't post stupid questions.
I'd make 100,000 look-a-like placebos and sell them to malpractice lawyers for $1,000 each. Not sure what I'd do with the real ones.
Don't you mean you truley hope he gets someone to edit his P.S.?
Give them to those whom can pay the most
Person who had the most potential or the people who I could relate to best, the most attractive people, and the ones who had the most severe condition or the ones that would pay the most money.
i'm going to assume the drug cannot be amplified or reproduced
sell 90 to the highest bidders, donate money to cancer research
keep 10 for friends and family
"The interviewers the medical school where I matriculated."