Okay. So thank you for coming. Welcome to several seminar on biomedical technology and more violent conflict.
I'm afraid speaking today is not your statue.
He's got to be talking to us about the rights of post medicine, somatic concerns about in biomedical technology.
And we've got a lot of time. So after the talk, we'll have a lot of time for questions.
And that's a great thing to talk about. Thank you.
Good morning, everybody. And thank you for being here this morning.
As you can see, I'm going to talk about some ethical concerns.
I should add some ethical, personal concerns about biomedical technology.
This is somehow a work in progress. So any comments and suggestions are more than welcome.
Now, the idea of this paper started from a conversation or chat that I had with a friend of mine who at some point
he went to talk to a doctor because he has three kidneys and he needs to go to the doctor on a regular basis.
And after he came back, he told me that he thinks that doctors have no heart, that they are heartless people.
And I was very curious because I knew that he went to a very good doctor in in Bucharest and asked him,
why didn't the doctor treating well, did the doctor offered him the treatment?
And he said, no, no, he was very good. I was, uh, I was feeling much better, doctor.
I went to the doctor, but I got the feeling that she didn't think that I'm a person, but he thinks that they were more a problem to be solved.
And then make the thinking.
And I started to look into this and this is what I got so far.
So I don't have a final conclusion from this to this paper.
Well, as we all know, today's magazine is more and more a matter of technology,
medical treatment and interventions not resistant by computer and even medical diagnostics are heavily imbued with technological barometers.
Of course, medicine, in a way, has always relied on technology such as scalpels, probes and other instruments.
But by the start of the 20th century, new instruments were available to study, diagnose and treat the body.
Today, hospitals worldwide use complex computerised machines to image to image the body or assist its function.
Now, using computers was one of the most important technological advancements in 20th century medicine.
They became central to medical care from the 1950.
Computerised machines in hospitals monitor patients continuously.
And they also enabled insurers and state run health services to track patient records on a massive scale.
Imaging techniques such and such as MRI or PMP were possible because faster computers to directly reconstruct images of the body.
More diagnostic tests were developed because automated laboratory machines perform death tests quicker and more accurately.
And this use of machines gave rise to specialist medical practitioners, as we all know.
Technological technology had a major role in medicine becoming more specialised.
Many medical technologies allowed specific parts of the body to be studied, diagnosed and treated.
And this land, of course, to doctors who specialised in certain organs, specialised in the case, liver, heart and so on.
These include ophthalmologists, doctors specialising in eye conditions and auto learning.
Biologists diagnose specialist devices such as the X-ray machine, introduced medical professionals such as radiologists and radiographers.
We are unknown before, but not all new technologies were readily accepted by the medical community.
Many were viewed with suspicion and in many cases with severe suspicion.
I would add in the 1950s, for example,
some doctors doubted an X-ray image of the chest was as reliable as a physical examination, a person to person examination.
Devices threatened were seen as the best friends to replace the diagnostic expertise of traditional medical practitioners.
Many doctors valued their clinical experience over machine produced information.
It may sound very peculiar to you, but we still have this kind of doctors in Romania today who think that machines are something strange.
We shouldn't rely too heavily on them. Other technologies failed because doctors or patients found them impractical.
ACG was only useful when it became portable and reliable enough to be used at the patient's bedside because in the beginning the big machine was very,
very big. But today we even have what's called stellar medicine,
covering a broad range of medical services from done in nursing to tell us psychiatry where
doctors offer medical care using information technology to patients from remote places.
Now, the use of machines, the use of technology brought some practical and ethical problems.
Safety concerns and ghosts have limited their use and still does.
Moreover, some historians and physicians argue that machines make doctors poorer here by encouraging them to focus only on the sick parts of the body,
rather than caring for the patient as a whole, for the patient, as a human being, as a person.
Many even question whether excessive use of technology within childbirth or to prolong life can be intrusive and do more harm than good.
As a side note, we. It could be said that advancing technology has presented physicians and patients with many other serious ethical dilemmas.
For example, ultrasound screens, foetuses for diseases before babies are born.
However, some parents must decide whether to terminate the pregnancy if the fantasy is revealed to have a certain condition.
So the question arises that medical technology imposed on us more than it empowers.
Because this gradual change birth may be a tremendous increase in medical efficiency.
And that's a fact. We cannot deny that.
But most important, technology also brought about a subtle change of the relationship between patients and practitioners.
I would say a certain relativistic shift towards a more fluid ontology.
That means that whereas in traditional medicine, doctors and patients were interacting with each other as human beings,
both as patients versus persons as specialists.
In today's medicine, this relationship became a relationship between certain technological functions.
Patients are medical problems. As I said before, proposals and practitioners.
Doctors are complex instruments which guide the solving process of those puzzles.
So it could be said that gradually but firmly.
Technology made us enter into what might be called what I call the age of post medicine,
which is an age in which we see patients as as medical or even scientific puzzles, more or less difficult to solve.
Of course, machines whose functioning need the interventions of other machines, especially designed for that purpose.
The patient is no longer seen as a person, which is a little something for the jargon, which is mostly substance.
But as a conglomerate of functions and parametres attributes which need to be studied thoroughly in order to fit their function.
And this is the shift I was mentioned before as an ontological shift.
Moreover, that not patients are no longer present in the physician's office, but only their charts and medical computerised data.
The patient becomes more and more the set of numbers and measurements which need
to be properly evaluated and brought to bear on a sick person in flesh and blood.
Someone might argue that this ontological shift, as I call it in the relationship between doctor and patient,
is not something bad in itself, as long as, of course it provides more accuracy and efficiency in medical care and medical treatments.
And she would be right if we consider this relationship strictly from a medical point of view.
There is nothing wrong with it. There is nothing wrong with changing the way practitioners interact with their patients,
which means seeing them as being more machine like, so to speak, rather than human life.
If this change brings with itself measurable medical benefits,
but the question arises again can we really ever consider this relationship between physician and patient solely from a medical point of view?
In other words, our physicians and of course, patients only that, namely, physicians and patients.
Because you see, Hippocratic Oath seems to imply something else, and we have the quotations from that.
The first one says, I want to remember that there is art to medicine as well as science,
and that world sympathy and understanding may outweighed the surgeon's knife or the canvas to drop.
And the second one says, I will remember that I do not treat a fever chart of cancer as growth,
but basic human being because illness may affect the person's family and economic stability.
My responsibility includes death related problems defined to care adequately for the sick because for the patient.
Now, from this point of view, it seems that technological progress broke with itself,
a huge improvement on the science part, but a smaller one on the art board.
You cannot manifest words, sympathy and understanding towards a bunch of medical charts and clinical data.
That's obvious. Well, to put it in more smaller terms, it seems that in both the medicine, as I called it,
patients are as persons are slowly but surely disappearing, being replaced by scientific and artificial medical constructs.
In short, patients are objectified in the name of precision and efficiency.
And this brings us to, as I said, the intermediary conclusion, because this is not final.
So. I may change that in the following months, whether it be subtle and inevitable change.
I guess it's inevitable we'll end up in a dramatic alienation of the doctor patient relationship or not.
Is, of course, still something open to debate. However, I do believe that we should we shouldn't wait to see if it would happen or not.
We should we should rather actively try to intervene to to influence the direction of
this gradual shift towards technology by finding ways to preserve or even improve.
If we could do that. The personal character of this very important relationship between doctor and patient
and the degree of human qualities involved in medical interactions in general.
Now, somewhere someone might might ask why I use that sort of medicine.
In a way, both medicine is like postmodernism in philosophy.
I think a postmodern philosopher, as we all know, is no longer interested to look for answers,
for those big questions from philosophical tradition, questions about truth, about beauty, about justice and so on.
Because he doesn't believe we can find answers to those questions and he doesn't believe those questions matter.
We cannot find a definitive answer to questions about truth.
We are always trying to tackle that question from a certain point of view, so that's useless.
What really matters to for such a philosopher is conceptual edification, as regents,
Rorty puts it through conversations and discussions, no matter what type of conversation or what kind of discourse we have.
Well, in a similar fashion, it seems to me that in what I call post medicine, the trend is to avoid somehow empathy,
sometimes not being that empathy towards the total stranger, which is the patient, is not really possible.
You cannot have empathy if that person is a stranger to us.
We can meaning, but we cannot have it gently and to concentrate on helping the patient with all means available,
even if for during this process, the patient could be seen as the medical puzzle and not as a human being.
And this is the reason I use the debt to impose medicine,
because I think that there are strong similarities between both medicine and what is usually called post modernism with all sorts of differences.
Of course, this is all. No, thank you.
They will get started again seconds later today.
It's not just the catch it looks like from the investor.
And he's going to be talking about how reputation might lead to different kinds of stories tomorrow.
Five and anything, huh? Okay.
This is The Talk is based on a paper co-authored with a friend of mine who appeared on Twitter.
And actually, I think, my gosh, he he said it would be interesting to give this to a newspaper.
I'm not sure if the paper got to anyone you the entire night and you can judge.
But if not, I would be happy to use any military might.
Some things probably are scattered out in more details in the paper.
Right. But by and large, I will follow the argument.
And I have to say that while this was a work in progress, I presented it three years ago, I think,
at the first Bucharest class of 75 verdicts, and I am very grateful to you guys for taking the time to come to this discussion.
I'm happy to see some of the things that were quoted in the paper here and some of them,
because it appeared to be Polish, because I had many good feedback and a vast array of the arguments.
So I start with this thing that I like.
TOBIN James O'Keefe is a famous economist, a Nobel Prize winner, a man talk about a conference and they have this quiet and that people change.
I mean, he's playing a classic.
They were arguing about the abortion issue.
So there's nothing more dangerous than a philosopher who's learned just a little bit of the times,
to which he replied with his well-known wit, unless it's an economist who hasn't learned anything about the first quarter.
And, uh, this is, uh, you know, this story somehow is mind blowing part of my stance in this project,
in this paper, and as a large commitment to start off argued.
So, uh, there would be some economic arguments here.
How will we come to this economic part and hopefully squeeze some interesting moral issues sort of out of the issue?
And the issue is, uh, on the topic of moral by has one, I would say I'm a,
I'm a moderate behaviour in the sense that at least for some kinds of moral,
by as long as, let's say individual voluntary enhancement, I can't find any compelling objections.
Uh, why look for other types of moral, biological.
And I would have reservations, but I think my, I just assume,
we just assume here and I'll go to my side that becoming a better person is uncontroversial, be a morally praiseworthy life goal.
So I think by and large everybody would agree with that, uh, that we should strive to become better persons.
Uh, and if taking biochemical processes in our bodies, uh,
proves an effective way of achieving this without harming self or without harming other partners,
then we think that least as legitimate means as the morally more traditional, traditional forms of moral enhancement.
And this is actually just saying that, uh,
we buy and join the others and we are sometimes arguments for other people for, and guys for our part of by enhancement.
The second assumption that they all want going to argue in favour of theory is that the economic
argument regarding the consequences of artificial scarcity induced by intellectual property,
at least by the current regime. People like your property are correct.
So intellectual property gives rise to the postcards.
And there are some things that always we shouldn't expect when having just cars.
Uh, however, we, we are not assuming that these arguments against intellectual property need to be decisive.
Uh, although. Well rather than my among others we've known, especially my brother.
So the question is, what are the likely consequences?
Can we explore some consequences of the car become natural property framework?
And we are only talking about dock payments here for both individuals who are willing to embark on the process
of morality and are willing to sacrifice this car for resources for achieving this biochemical means,
who are willing to pay money in order to buy drugs that would help them reach is you
go subjective and are some of those consequences morally interesting or relevant?
And we are only looking, as I said, of individual and voluntary by the hospital either quickly wrong or if one thinks about intellectual property.
And first, I do think we need to distinguish between ideologic right and their material support, on the other hand,
and an intellectual property right piece, a property in the union objects which are instantiated in the material support.
So when you buy a book and the book is copyrighted, you only have a property right over the physical paper.
You don't have any although you bought the boat,
you don't have any property derived over the idea of the text that is instantiated in the material support differences.
Thank you. That's a paper from 2000 time from Laura Byron.
And she makes this distinction on intellectual property, right?
It's a property, right? I feel fine. Why the more position on property rights referred to rather both for particular objects.
So types of intellectual property rights, copyright, patent, trademark documents, sequence.
And we are only considering here pharmaceutical patents.
If you've made it, I'll come back to this in the discussion.
A patent is a property rights or any variety regarding the invention of machinery or a process that has a useful function.
And in particular, drug patents are usually property rights either over chemical formula or over
industrial processes leading to the production of that particular product.
What is that, Gene? Bye bye. A bite.
It's actually the holder, which can be the holder can be more advanced or can be a compliment.
The holder gets a limiting or monopoly over overvalued drug, in effect, the holder of this iPhone.
Has the right of excluding others from benefiting or utilising without the permission of the holder the result of being the to war.
And there might be many justifications in favour of granting this form of property.
Right. There are armed gangs in the ancient and prone back of my mind, so I should be aware of that product, etc., etc.
But I would say the most common argument we would cite, the most common arguments rests.
On. On a theme that is well-known economics.
I mean, the importance of incentives. And it goes something like because the cost of copying that idea is so low, it's close to zero.
Uh, inventors need to be incentivised, otherwise nobody would complain.
Otherwise we wouldn't have any sort of creativity.
And it's really this monopoly grant. And by buying a patent, it's a way of incentivising creativity.
As always, with regulations under law, there are an entitlement, but maybe not so much intended consequences.
Unintended consequence is to keep incentives for people to be created.
Oh, and why? Pharmaceutical industry in particular would need this sort of value?
Because some people would argue it meets the features of what economists call the schumpeterian industry.
Right? Marginal cost, small and constant marginal costs and innovation, those that are most important, competitive.
But okay, let's take a step back now.
And we generally talk about property rights, about the emergence of property rights in the context of the cars.
And although it's the well-known story in the killing field to supplement nature,
where he argues that we need rules of justice and property because resources, things are cars.
And if we don't have rules of property and justice, conflicts over the use of things without care.
And in a more tactical approach, the economics of economics are property rights or new institutional economics would say
that the function of property rights is that of internalising negative externalities.
And yeah, that holds for laptops and classes, chairs and tables.
But let's talk for a piece. I mean, if I have a laptop and long past it's my laptop, then I walk out of that.
Should have a lot. Be fine. I have. I go and let's say.
Can you be the bad guy, please? Yeah, I will still have that feeling.
In the same sense, what happens is that in a word, there would be two persons enjoying that particular cookie instead of just one person.
Okay. So. What's particular about intellectual property is that if traditional property rights holder materials are meant
to solve the problem with regards to intellectual property rights arguments to induce creative staff action.
Okay. And there are some effects of scars of creating scars left availability,
usually all things, all other things being equal, higher prices always went up.
That's the basic way of how the law of the land operates and has a secondary consequence.
A decrease in consumption, particularly for any individuals, would incur a higher opportunity cost for purchasing that particular thing at trial.
And you could probably now see where the argument is going again that I would skip over the case
studies that are well documented by inferences about how drunk patrons actually lead to huge,
steep increases in prices like, you know, in the study in 2002 in South Africa.
So the difference between a patented patented drug, $1,200 of HIV y and the generic equivalent would be 350.
That's almost four times. And then it happens again and again.
And probably you can already see where this is going.
Straightforward argument from the wrong man who would say something like this if drug use or more of
violent crimes are facing you and leave everything that in my scenario partner holds then higher prices.
Artificial scarcity would lead to a smaller quantity demanded by the consumer.
So the less you have less people becoming better persons.
And sorry much.
Yeah. That's straight forward. And I might that would be those people that cause demand increase the ones that preyed upon opportunity.
So maybe the not so wealthy persons but this might be too straightforward problem and I think it is something to strive for because maybe, maybe, uh,
maybe a possible objection will say something like, okay,
about drugs or more of the buying aspects are not just any kind of, they're, they're that kind of work that is.
Unaffected in consumption by changes in price that embodies what economists call in a.
With regard to pricing, there are two ways to produce.
These are called usually Veblen goods. I think first time the problem the first author told well you're right and you can save by a
morally impossible target like retailing or you other examples I think it's actually generic.
It's not about a greater than market,
but maybe not the sort of position of to look like Rolls-Royce cars or fancy cosmetic compact appliance or I don't know, making that work for you.
That's an action, the actual objects.
And then we would be okay with that because it would only show that these sort of drugs would be desired and used mostly.
By people with enough money to afford a position on good.
I mean, if my working class contracts aren't the Rolls Royce of Rolls Royce is on Fox.
Then we can wrap our case here.
But maybe there's something else. Maybe there's something so peculiar about morality that would make these rods of that language.
Maybe the motivation to obtain more of these thoughts of people who volunteer.
Let me remind you, we're only talking about voluntary, you know,
so maybe the desire is so strongly people want to become a part of this that they will actually disregard price increases.
This could be a more promising life.
But I'm a hard woman. But what would.
What the he continues to face usually with faced with these sorts of arguments is look at what's
called usually the 40% mark when a good a particular group becomes unavailable or huge scars.
You look at the markets for goods that can.
Of this partially substitute the artificial calzone and what is the substitute?
MARTIN For more of my time. It could be the more traditional form of more personal education, taking ethics classes.
I don't know. I don't know. The situation is actually. Box for my dream.
But I wouldn't say that these courses are the most popular in Romania where we don't track that bad.
But it's not the theme that students flock to professors or other sort of available
services for more of an education doesn't seem that people are so usually interested.
So we might probably more plausibly more possibly say that more than the house,
but by more as one occupies different places in the preference dreams of various things.
And it would be quite, quite adventurous to assume that morally impossible is an existential priority for most individuals.
Of course, finally, philosophers might say it should be other essential criteria.
Maybe it should be like such a priority. But I don't think.
The kind of data and insights that we have point to being actually having Central Park.
So who would be the likely buyer and user of relatively more expensive drugs?
Individuals with strong, very strong desire to become morally harmless and for various reasons,
making opportunity cost reasons and efficiency reasons and other kinds of reasons would see the biological way as the sort of thing for the Quakers,
etc., etc. But then how do you know that they are there by their team?
I think Steve, he has a phrase the bad apples problem and usually an important argument in favour of buying.
One is that you can have all these bad Apple products.
That's. Many people to my name Julianne some members of the for the book is actually the.
So called bad apple problem of dangerously available access to weapons, etc. etc.
But then the problem would be that if this economic argument holds water,
then people who would embark on this project of of my gasoline would be people that are already that
people that would sacrifice money to become better persons are people who by traditional philosophy,
are already, in a sense better persons,
because are those people who strongly desire to become better persons and are strongly committed to embark on this process.
I mean, they can subsidise the kind of morality, utilitarian, etc. In any substantive account of morality, you'll find funds like this.
It is important to really want a moral path and if you really want it,
you are already higher in that sense than the person that does not want to become a better person.
So, uh, it wouldn't be those bad apples that mean more than half of them would sacrifice money in order to get the prize.
It would be the person that are already protecting themselves in terms of what people are.
So.
But yeah, that that can be one of the things I really, really would not buy and buyer would not go willingly to buy an organ transplant by themselves.
So that's not a problem. But for them [INAUDIBLE] about the worst that yet and we think there's still an important range of consequences for.
We call them in the paper the not so bad by that.
So to see who are the not so bad, bad apples.
Uh, let's look at this magic here.
Here. We would have potential consumer or wealthy consumers or consumers.
And I have to say that affluent, non-athletic friendly in terms of revenue, opportunity, cost, not we don't want to try to solve the financial crash.
But you are more of an expert here than you are here, right?
Uh, and you can say that are, they can have a designer Wal-Mart in a morally project fashion,
fashion designer, for example, or that they are willing to consider embarking on, on this project.
And somewhere over here would be those really bad apples who don't care about and they wouldn't do anything.
But now imagine the scenario. Imagine this, uh, joke about, uh, who knows something about this happened?
Who knows that he can become quite of fine print and he's not hyperbolic.
That happens very, very rarely. But he knows that when it happens, uh, he can be common danger for his family.
And we chose this is because, you know, we now we still have huge problems with both domestic violence and uh,
and I live in, mostly in my village as well as even more in other parts of Romania is right.
Uh, imagine he's joke he knows he has this problem and one more he looks like a paper
or that he and here's the problem drug that inhibits violence severe and he says
things okay then that's a sort of extra precaution that they can do I can what he did
before in the scenarios avoid as much as possible any kind of triggering context.
So any context in which drinking would be a given going out with the colleagues, etc., etc.
But because that's I can think this text because I haven't been always successful in the past in avoiding these triggering conflicts,
uh, and nobody's going to want to go and buy that product.
One thing which I'd say is that the cheaper, the cheaper the drug.
The most plausible means for Joe to buy the truck, of course.
Uh, but it's not the only thing that we can say.
Uh. We can say that it becomes them.
On the one hand, the matter of racism. That.
Because he could argue, he could say, well, I know this is our but it never happened.
I came out and he sat in on that one job and instead of.
Sacrificing this money in order to buy the drugs and the property costs.
I would rather invest the money.
I would rather spend the money to provide better food for my children.
I would rather spend the money to get them a better education.
Why would I spend the money with my my restaurants?
So for, let's say, the facts of our car speed price increase for our class based on would be largely unimportant for affluent Joes.
I would say even affluent persons with a strong desire to become a better person then probably by increasing price,
would not change consumption and way for them to conceive.
Or maybe if they're the kind of moral snobs that would buy from more affluent targeting of the market equivalent of Rolls-Royces.
You don't get it. But here either Joe can fall either here or there.
We the same with important differences but with with even more importance to the American.
They would be less inclined on their artificial scarcity to invest, for they invest rather their resources into more of the buying pathway.
And this does not the fact, as I said, really the worst attack on us we can imagine,
but it would affect the incentives for more than by the council, for those people that are reasonable, a reasonable and plausible target for us.
I mean, average Joes who would want to become better persons would be in a certain state of the world,
are willing to spend resources in order to become another person,
but will still have to prioritise spending those resources over other things and the
way agents prioritise to relate of their their subjective higher goals of priorities.
Always. Well, this is the weak version of what we think.
We have argued in the paper that drug patents provide some incentive, at least for voluntary moral buying.
And we think this is supported by the argument and maybe there is more of the important more than just be squeezing out of part of this argument.
Uh. We hope at some point to write a second paper arguing for a considerably stronger.
That one cannot be consistently both a supporter of one of the binding possible
and a supporter of the current configuration of intellectual property rules.
But with we are still quite a long way from getting better.
Maybe we won't ever get there. We would like to.
I'm not sure we can get there. So. Yeah.
Thank you.