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Susan Axelrod and Joe Biden Should Register as Heath Care Lobbyists

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In a recent post noting Barack Obama's limitations as a comedian, I cited his well-known roast of Rahm Emanuel, which took place at a fund-raiser for Citizens United for Research in Epilepsy, organized by Susan Axelrod.

I spoke about Ms. Axelrod and her cause in my post, "Health Care Policy by HuffPo Celebs," to wit:

I watched on Morning Joe as the beautiful (both inside and outside) Susan Axelrod, wife of David (everyone's favorite political operative), proselytized for more money for the care of and research on epilepsy, from which her and David's daughter unfortunately suffers. How could your heart not go out for their family? NBC's medical editor, Nancy Snyderman, meanwhile intoned that not enough was being done in research on epilepsy and other "broad-spectrum" neurological disorders. Is this true? Or, to put it another way, should TV appearances by influential individuals be the way we make this decision?

Obviously, the Axelrods are deeply concerned about their daughter, and want to see great investments made in what ails her. But what if she had autism, or spina bifida, or childhood diabetes, or hydrocephalus? You see where I'm going - why should Obama (albeit before becoming President) be speaking to obtaining more funding for one of these diseases over another simply because he has friends and political allies with a child with that disease? Is that how American health care policy should be determined?

As we are fast becoming acutely aware, there is a limited health care and research pile of dough to be divided, and we have to have some rational, ethical, economic basis for making these decisions. Ironically, this is one of the principles President Obama has introduced into the health care debate in the United States. Doubly ironically, one of his key advisers in this area is Rahm Emanuel's brother Zeke. Writing in the British medical journal The Lancet earlier this year, Emanuel and his co-authors advocated as an ethical basis for allocating scarce medical resources:

the complete lives system [which] combines four morally relevant principles: youngest-first, prognosis, lottery, and saving the most lives. . . . Importantly, it is. . . a framework that expresses widely affirmed values: priority to the worst-off, maximising benefits, and treating people equally. To achieve a just allocation of scarce medical interventions, society must embrace the challenge of implementing a coherent multiprinciple framework rather than relying on simple principles or retreating to the status quo.

I think it's safe to say Emanuel et al. do not consider one relevant ethical principle for assigning health care and research resources to be, "Having the most influential boosters." (In a follow-up letter to their article Emanuel and his colleagues note: "equitable, non-corrupt health-care systems are an important part of ensuring fair access to scarce lifesaving resources.") Has no one ever questioned the President favoring his close friends' preferences for such allocations or their lobbying him for support?

There are many other examples of log-rolling in health care financing by powerful political figures. For example, Ted Kennedy has been the major source for seeking parity in insurance coverage for addiction, based on his son Patrick's frequent drug relapses. It is as hard to be critical of this funding thrust as to question research money for epilepsy. However, the 12-step treatment that Patrick Kennedy repeatedly receives for his addiction - the standard one administered around the country - has never been shown to be effective. (Disclosure: I am the creator of an alternative addiction treatment program which receives insurance reimbursement.)

Which brings us to everybody's favorite crazy uncle, Joe Biden. Did you notice that Joe was the only one drinking a non-alcoholic beer at the recent bash on the White House lawn? Uncle Joe clearly has issues around alcohol. This may explain his introduction - just prior to his nomination for the Vice Presidency - of the bill titled, "Recognizing Addiction as a Disease Act of 2007." The bill declares that "Addiction is a chronic, relapsing brain disease." (Disclosure: I would be arrested under this law, since I have repeatedly argued that viewing and treating addiction as a disease is harmful.) The primary provision in this bill - aside from dictating how we should think about addiction - is to change the name of the National Institute on Drug Abuse to the "National Institute on Diseases of Addiction."

I have five questions for "crazy" Joe:

  1. Do you think gambling, sex, and shopping can be addictive?
  2. If so, will this new institute deal equally with these matters along with drugs?
  3. Do you believe people can use illicit drugs without being addicted to them (cf. Barack Obama)?
  4. If yes, will the new institute thus ignore non-addicted drug use and users?
  5. Will the new institute address people who are addicted to pharmaceuticals prescribed by their physicians?

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