Something Happened to Women’s Health in the 20th Century
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I’ve been working recently on the relevance of growing income and wealth inequality for the issues of concern to bioethics. Gopal Sreenivasan pointed out in the Hastings Center Report a few years ago that universal health coverage is no panacea for social … Continue reading

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Piketty and the Primates of Park Avenue; or, Women and Wealth

When I was working on my review essay on Piketty’s Capital in the 21st Century (forthcoming in the fall in IJFAB), I was looking around for sources about women’s fate under regimes of extreme inequality—in wealth in particular, given Piketty’s … Continue reading

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Gender and Inequality: Panel at LSE’s day-long engagement with Thomas Piketty

I was back in London on Monday for a day-long symposium at the LSE on Piketty’s Capital in the 21st Century—this time, with Piketty in attendance. At least, he was there after his late Eurostar train got in from Paris. … Continue reading

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On the Alzheimer’s Report

I saw a lot of surprise on social media about the Alzheimer’s Society report including that data that only 45% of patients and their caregivers are informed of their Alzheimer’s diagnosis. News reports went so far as to put out … Continue reading

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Four reports from an afternoon on Thomas Piketty at the LSE, Part 4:
The local and the global

The LSE half-day discussing Piketty’s Capital in the Twenty-first Century and the implications of rising inequality for politics and policy closed with a focus on local social policy dimensions and global politics. This is the last of four blog posts … Continue reading

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Four reports from an afternoon on Thomas Piketty at the LSE, Part 3:
Piketty, politics, and policy

The Comparative and International Political Economy group at the LSE hosted a half-day discussion of Thomas Piketty, politics, and social policy, on the growing economic inequalities that Piketty and his collaborators document and what can be done about them, based … Continue reading

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Four reports from an afternoon on Thomas Piketty at the LSE, Part 2

A group of political science and social policy faculty gathered at the LSE on March 9 to foster the conversation around politics and social policy in an era of widening inequalities. As I wrote in my last post, I have a … Continue reading

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Economic inequality, politics, and social policy:
Four reports from an afternoon on Thomas Piketty at the LSE, Part 1

What does the Occupy Wall Street slogan of the 99% and the 1% have to do with bioethics? I have just worked through edits with Kate Caras, our senior managing editor at IJFAB, of my review essay, “Piketty and the … Continue reading

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Health Reforms in Mexico

I’m winding down my time in Mexico City at the FAB conference and the International Association of Bioethics — my first ever on both counts. It was exciting to meet so many folks in person, especially at my first meeting … Continue reading

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Private Imaging in Alberta

Canada’s single-payer health system is the envy of some Americans. Under Canadian Medicare, every province runs a single public health insurance plan with very low administrative overhead: in this sense, the system is efficient. It is also a natural fit for the goal of health equity: everyone is in the same plan; everyone has the same benefits.

A single-payer system is no panacea, however. Much rides on what the single payer covers and does not cover. For example, Canada scores poorly on international comparisons of health equity. This is largely, but not entirely, the result of what we exclude from Medicare: prescription drugs, as well as non-physician care (physical therapy, dental care, speech language pathology, etc.—any function not performed by physicians), in the community. As a result of these exclusions, Canada has a high rate of private health insurance for extended benefits, and one of the highest levels of private expenditure among universal health care systems. If you need rehab, or have on-going prescription drug costs, moving to Canada might or might not save you from American-style inequities in access to care.

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Who is cancer prevention for, anyway?

In the era of biocitizenry—when how you manage your medical risk is part and parcel of good citizenship—identity is a crucial mediator. Who you are is who you are like, and who you are like is whose narrative you can slip into: celebrity greases the deal. Whether that narrative is a comfortable glove that fits you just right, or a bus you jump on in a hurry, only to realize later that it took you just where you needed to go—or in the opposite direction—may be both a metaphysical question, and one with real consequences.

Angelina Jolie’s revelation in the NY Times of her carrier status for the BRCA mutation and of her choice of prophylactic double mastectomy was well-measured. She highlighted several important facts that frame the diversity of people’s experience and choices to set a context for her own moving personal narrative, such as that the BRCA gene mutation is responsible for a small share of breast cancers, that access to the test is hindered by its cost (Myriad’s patent as the most significant driver of that cost went unnamed), that the biggest disease burden is borne in lower-income countries, that the choice of approaches to prevention is personal and best discussed with your physician. Her physician blogged the treatment regime, but only after the news cycle and blogosphere were forced to content themselves for a day with the policy issues of patents (read Leila Jamal at The Berman Institute’s Bioethics Bulletin on the Myriad patents and the case before the Supreme Court), access (read s.e. smith’s harrowing account at xojane of knowing her BRCA status but being unable to afford preventive treatment), and what may have been the source of her self-reported 87% lifetime risk of breast cancer (Tiffany O’Callaghan interviewing Allison Kurian at The New Scientist), as well as the misogyny flung Jolie’s way (you may want to skip the tumblrs filling with variants of the “poor Brad” meme from twitter).

s.e. smith

Most women choosing double mastectomy as a prophylaxis for breast cancer are not women with the BRCA mutation. If there were a sweepstakes for bravery, Jolie’s worthy competitor would be Peggy Orenstein, who wrote two weeks ago in the NY Times Magazine about how her advocacy for early detection via mammography screening was transformed as she came to understand the depth and extent of breast cancer overdiagnosis. The issue of overdiagnosis, to be clear, isn’t about the distress and uncertainty that comes with false positives. It’s about unnecessary medical treatment: surgery, radiation, and chemotherapy for breast cancers that would never have killed if left alone. The recent Canadian Task Force on Preventive Health Care update of the similar US body’s guidelines quantifies overdiagnosis for women undergoing screening in their 40s as 10 cancers treated unnecessarily for every life saved. Jolie faces visceral misogyny from her so-called fan base; Orenstein faces the ire of the screening advocates. I’m not sure which is worse.

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