The 100 pills interview question

[dynx]

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).

What are you smoking dude? Have you ever been involved with treatment in a cancer patient?

This is exactly why pre-meds and younger people in general should just STFU when it comes to policy decisions. Hearts are in the right place but you're uninformed opinions lend credibility to positions where its not due.

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[dynx]

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

This is the most reasonable answer I have seen.

 

[45408]

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"

I think it's pretty obvious - if the president of the United States desperately needed a liver transplant, don't you think he'd get bumped up a little on the priority list? Or would it go to Mr. Dubois first?

 

[45408]

This is the most reasonable answer I have seen.

Well, buy a Ferrari or five for yourself first. then donate the rest.

 

[Krisss17]

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.

I like your answer. My first biggest thought, especially after Baylormed put down their response was, who are we to say that the value of a mother/father of three is more or less valued than a single childless person.

Who hasn't had the thought that they would want to provide for our own families with some of those pills, does that mean that anyone else is not worthy of this miracle cure? No, but emotion and logic don't always work together.

It definitely does not have one clear cut answer. If you are going to be altrusic (sp?), it's not going to sound authentic unless you are Mother Teresa.

 

[IWant2BeADoctor]

How about this one. Sell them all, rake in 100s of Millions if not Billions and start my own Private Med School and with moi as President. Start the world's first MD/MO/PhD/JD program...graduate from it and become the world's first MD/MO/PHD/JD.

Blessed be the coat that carries those acronyms.

 

[patrickd223]

sell them for billions and donate the money to cancer research. oh yeah and keep one for myself

 

[FemalesCANTDriv]

tell the people who want it to submit their GPA and MCAT scores.

Take that adcom!

 

[FemalesCANTDriv]

well personally, i say it is a trick question. if you cannot reproduce the medication, then you might as well throw them all away or hide them for some uber-important, highly secretive occassion. i mean, what if someone discovered time travel but could only do it for 5 people. that could bring more hazard to the world than good in theory (as could the pandemonium caused by ppl finding out there is a cure for cancer but only for 100 ppl). i say take the pills to area 51 and forget about them.

 

[SurgeonUFO]

If you had exactly 100 pills that could cure cancer, how would you decide who to give them to?

First, I'd make every potential buyer fill out a "common application," including, as a part of this common application, scores from an 8-hour examination detailing their understanding of the disease.
Due to mystery magicks, this common application will take "some time" to be processed. After processing of this application, and receipt of upwards of $500, I'd send everyone a "secondary" application, depending on their type of cancer. For some cancers, they'd just be asked to send in an extra $75 dollars and write their name again. People with harder to cure cancers, will be asked questions such as "Why do you want to be cured of cancer?" and "How will curing you of cancer lead to increased diversity of the human genome?" Those with the hardest cancers of all to cure will be asked questions so lengthy and ambiguous that they are forced to give up immediately. All secondaries will require extra money.

After receipt of the secondaries and payment, absolutely nothing will be done. Unless payment wasn't received, in which case we will make sure to quickly notify the applicants. Nothing will be done for months. This will give time for some people to die, thus lowering the applicant pool. After a few months, we will invite people we have an interest in to come interview at our hospitals. To those we are not interested in, we will most likely say nothing for a few more months. While we will not charge money for the interviews, we will also not offer financial assistance to those coming from a long distance. At the interview, any trace of humanity will be noticed and considered a negative factor in the review of their application. People will make mental notes of everything they say, and especially how they are dressed. The interview will last anywhere from 20 minutes to an hour and a half. At the end of the interview, we will say nothing about the status of their application. We will wait a few more weeks, giving time for more people to die.

At this time, we will begin to hand out our 100 pills. Only to a very select few, of course, those who have the ability to play this application game the best. Those who we are less interested in giving the pills will be put on a waitlist. This waitlist will last until the apocalypse or we run out of pills, whichever happens first.

 

[gujuDoc]

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.

They may be producing more somewhere but not in an as easy reach place at the particular moment you need them.

That said, I kinda like LizzyM's response. But at the same time I also kinda feel that Baylormed has a good point in that if there were tons of children with cancer and elderly people near the end of their life with cancer I'd want to give it to the child because the elderly person has already lived out most of their life. Also, I don't agree that criminals esp. people like rapists, molesters, etc. who have cancer should be given the same rights as someone as the average person especially if that person has committed homicide.

 

[gujuDoc]

What are you smoking dude? Have you ever been involved with treatment in a cancer patient?

This is exactly why pre-meds and younger people in general should just STFU when it comes to policy decisions. Hearts are in the right place but you're uninformed opinions lend credibility to positions where its not due.

 

[LizzyM]

That said, I kinda like LizzyM's response. But at the same time I also kinda feel that Baylormed has a good point in that if there were tons of children with cancer and elderly people near the end of their life with cancer I'd want to give it to the child because the elderly person has already lived out most of their life. Also, I don't agree that criminals esp. people like rapists, molesters, etc. who have cancer should be given the same rights as someone as the average person especially if that person has committed homicide.

Thank you for the thumbs up.

The value of children over the older adult and discrimination against those who have been found guilty of breaking certain laws shows the values of the responder. It says that some people are more deserving of medical treatment than others. I still contend that such a response is "taking the bait" and can come back to bite you.

 

[baylormed]

They may be producing more somewhere but not in an as easy reach place at the particular moment you need them.

That said, I kinda like LizzyM's response. But at the same time I also kinda feel that Baylormed has a good point in that if there were tons of children with cancer and elderly people near the end of their life with cancer I'd want to give it to the child because the elderly person has already lived out most of their life. Also, I don't agree that criminals esp. people like rapists, molesters, etc. who have cancer should be given the same rights as someone as the average person especially if that person has committed homicide.

Thanks!

I also agree with LizzyM and in no way was I suggesting that any life is more valuable than another in the literal sense of the word. However, it makes me think then than these decisions do have to be made. Transplant committees for example. They may choose solely on a medical basis (who needs it the most, who has the better chance of survival, etc) but they still have to choose.

I think in someways saying I couldn't choose is taking the easy way out, because choices DO get made by someone, somewhere, eventually.

 

[gujuDoc]

Thank you for the thumbs up.

The value of children over the older adult and discrimination against those who have been found guilty of breaking certain laws shows the values of the responder. It says that some people are more deserving of medical treatment than others. I still contend that such a response is "taking the bait" and can come back to bite you.

Yeah I see your point. I suppose its hard to predict what I'd do in a real life situation and you do bring up a big point. I did recently find an interesting link on here about bioethics that I think brings some similar kind of examples of things. Its from UWashington's med school. I'll have to post the link for those interested.

 

[gujuDoc]

Thanks!

I also agree with LizzyM and in no way was I suggesting that any life is more valuable than another in the literal sense of the word. However, it makes me think then than these decisions do have to be made. Transplant committees for example. They may choose solely on a medical basis (who needs it the most, who has the better chance of survival, etc) but they still have to choose.

I think in someways saying I couldn't choose is taking the easy way out, because choices DO get made by someone, somewhere, eventually.

I think this is why LizzyM has stated the all or none phenomena of not giving it to people if there arent enough for everyone.

 

[baylormed]

I think this is why LizzyM has stated the all or none phenomena of not giving it to people if there arent enough for everyone.

Would you stop transplanting organs because there aren't enough for everyone?

 

[dsh]

Wouldn't the fair thing to do be getting a large sample (as large as possible) of afflicted patients and giving out the pills using randomly-generated numbers?

 

[LizzyM]

I never said "all or none". I did point out that when there are far fewer slots than there are willing study subjects, that the decisions are made by lottery (this occurred early in the AIDS epidemic when most of the potential research subjects were relatively young, unmarried men.)

Organ transplant is an interesting situations and some now argue that the current system of providing preferentially to the sickest saves fewer lives than would be saved if the organs went to those who were less ill and better able to survive the transplant.

The early years of dialysis machines had "God committees" that were not unlike the question of 100 pills. Transplant was not an option and those not selected for dialysis did die of kidney failure.

 

[Chinorean]

My official interview answer would be along the lines of "Set up a committee comprised of experts to review each case, because no one person should have the power to decide who lives or dies."

But honestly, if these 100 pills really did exist and they landed in my pocket I wouldn't tell anyone about them. Pretty much anything you do with them will guarantee that a large group of people will hate and condemn you. Your life would probably be in danger because people will want to steal them and make a nice profit or punish you for making the "wrong decision." So I'd mash up a couple for lab analysis and then secretly distribute the pills to patients based on my own value judgements and then sleep well at night because I did what I thought was right and not what someone else believed in.