“仅仅关心”：我们能否承担规避癌症耐药性的伦理和经济成本？
"Just caring": can we afford the ethical and economic costs of circumventing cancer drug resistance?
机构信息
Center for Ethics and Humanities in the Life Sciences, 965 Fee Road, Michigan State University, East Lansing, MI 48824, USA.
出版信息
J Pers Med. 2013 Jul 16;3(3):124-43. doi: 10.3390/jpm3030124.
Personalized medicine has been presented in public and professional contexts in excessively optimistic tones. In the area of cancer what has become clear is the extraordinary heterogeneity and resilience of tumors in the face of numerous targeted therapies. This is the problem of cancer drug resistance. I summarize this problem in the first part of this essay. I then place this problem in the context of the larger political economic problem of escalating health care costs in both the EU and the US. In turn, that needs to be placed within an ethical context: How should we fairly distribute access to needed health care for an enormous range of health care needs when we have only limited resources (money) to meet virtually unlimited health care needs (cancer and everything else)? This is the problem of health care rationing. It is inescapable as a moral problem and requires a just resolution. Ultimately that resolution must be forged through a process of rational democratic deliberation.
个体化医学在公共和专业领域被以过于乐观的语气呈现。在癌症领域，面对众多的靶向治疗，肿瘤的非凡异质性和抵抗力已经变得清晰起来。这就是癌症药物耐药性的问题。我在本文的第一部分总结了这个问题。然后，我将这个问题置于欧盟和美国医疗保健成本不断上升这一更大的政治经济问题的背景下。反过来，这需要放在伦理背景下考虑：当我们只有有限的资源（金钱）来满足几乎无限的医疗保健需求（癌症和其他一切）时，我们应该如何公平地分配对各种医疗保健需求的获取？这就是医疗保健配给的问题。作为一个道德问题，它是不可避免的，需要公正的解决。最终，这个解决方案必须通过理性的民主审议过程来制定。
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