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</o:shapelayout></xml><![endif]--></head><body lang=EN-US link=blue vlink=purple><div class=WordSection1><p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D'>In my studies, I keep bumping into memes like this one, which make me squirm:<o:p></o:p></span></p><p style='text-indent:.5in'>Additionally, off-label use raises questions of fairness. Insurance companies do not usually cover off-label use of a drug, which means the patient will have to pay for the cost out-of-pocket. This can be prohibitively expensive. For example, the WSJ report on the drug approved to treat MS and may relieve ALS symptoms is called Gilenya and costs around $52,365 per year. Therefore, only those who can afford the hefty price tag are able to try Gilenya off-label, while poorer patients, or those that do not have an extra $50,000 available, do not have the option of using Gilenya for off-label use.<o:p></o:p></p><p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D'><a href="http://blogs.tiu.edu/bioethics/2012/02/20/clinical-trials-or-off-label-use/">http://blogs.tiu.edu/bioethics/2012/02/20/clinical-trials-or-off-label-use/</a><o:p></o:p></span></p><p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D'>This notion can be extended to the kinds of advances we transhumanists might expect. We may find technological advances which allow superior performance, such as steroids for instance. Are we then expected to eschew these advances because every yahoo cannot afford it? What if we find out that bexarotene really does cure Alzheimer’s? What if we are then told we cannot have it because every Alzheimer’s patient cannot afford it? Wouldn’t be fair you know. <o:p></o:p></span></p><p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D'>Sooner or later, it will occur to the population that if bexarotene helps Alzheimer’s patients, perhaps it will also help those who do not have Alzheimer’s but whose youth occurred tragically many years ago, and these have sufficient funds to finance the meds themselves. Why not? Do we need to hold up every medication until some magic single payer comes along, willing to buy every medication for everyone? In the meantime are we expected to do without?<o:p></o:p></span></p><p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D'>Bexarotene is a great test case. It is expensive, but not THAT expensive, and waaay cheaper than institutional care. It is a good example of a medication which some people will be able to afford easily, others will be able to afford with some discipline, and for some it will be as far out of reach as the moon.<o:p></o:p></span></p><p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D'>Do we have medical ethicists among us who can offer guidance? What is money for? Why should we work and save if we are not allowed to use our money any way we please? Are we to eschew cryonics because everyone cannot afford it?<o:p></o:p></span></p><p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D'>spike<o:p></o:p></span></p><p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D'><o:p> </o:p></span></p></div></body></html>