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Drugs Are No Different from Other Commodities

It is common to design university courses around available books, to create a wardrobe around available clothes, or to design an ornamental garden based on plants available at the nursery. These choices are shaped by the relevant industries. These industries are not free of moral responsibilities, but (hoarding, budgeting, and labor issues aside) it seems reasonable to choose a sweater simply because it is available and attractive.

Books, clothes, and gardens might seem irrelevant because they affect health only indirectly. Dietary decisions, however, affect health directly. When I cook dinner for my family, I make dietary decisions based on available ingredients. These ingredients are themselves shaped by what is in the store or what is in our share box from the community-supported farm. How is treating according to available drugs different from cooking according to available ingredients?

Perhaps the relevant comparison is not what to cook for the main course but whether to have dessert. Cheesecake is not a need but a luxury. Because choosing to eat cheesecake too often can be bad for our health, it would be contrary to duties of medical beneficence to cause people to believe that cheesecake is a necessary or expected part of dinner. However, those who make and sell cheesecake in diners along New Jersey’s Routes 1 and 9 do not (at least not qua diner owners or cheesecake mongers) have such a duty. They have a duty to refrain from deception, but this duty is consistent with pages of high-calorie entrees that come with soup, salad, soft drink, and dessert. If these menus threaten the health of the residents of the Garden State beyond tolerable limits of caveat emptor, it is up to the state to set limits.

Such limits would constitute state paternalism (in this case, Garden State paternalism) and reflect widely accepted duties of government. As a matter of fact, New Jersey took action against the dangers of runny eggs in 1992 (Osgood 1992).[1] The system for regulating drugs in the USA is similarly paternalist (Flanigan 2012). Some drugs (such as acetaminophen) are available over the counter, some (such as Prozac) by prescription, and some (such as crack cocaine) are banned.

There may also be a difference between self-pay treatments and treatments where the cost is distributed among members of a community or a group covered under a common insurance contract. We can accept that health insurance ought to cover all and only treatments that are “medically necessary” without thinking that other treatments (teeth whitening, removal of benign moles, etc.) should be universally withheld. But even then, communities with sufficient resources may and perhaps should support treats. A case in point is that cake and ice cream are both allowed purchases for those receiving SNAP benefits (Supplemental Nutrition Assistance Program, also known as food stamps) in the USA.[2]

In short, drugs are not unique in their status as commodities that affect health and are peddled by those who have no special obligation to medical beneficence. Recommending or requesting a drug that is not medically necessary may be no more or no less problematic than choosing a food that is not nutritionally justified.[3]

  • [1] New Jersey’s ban on eggs over easy was later repealed, but Brookline, Massachusetts, successfully banned commercial use of trans fats (Abel and Guilfoil 2007). In a similar move, New YorkCity has attempted to enact a ban on extra-large soft drinks (Grynbaum 2012).
  • [2] I have absolutely no objection to the following: “Items such as birthday and other special occasion cakes are eligible for purchase with SNAP [food stamp] benefits as long as the value of nonedible decorations does not exceed 50 percent of the purchase price of the cake” (SupplementalNutrition Assistance Program 2014).
  • [3] On the general principle that one philosopher’s modus ponens is another philosopher’s modustollens, the comparison can be used to defend either greater permissiveness or greater paternalismfor both food and drugs.
 
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