Vuk
Good, Better, Best Medicine?
In our class we have discussed many technological advancements that
promise to thrust us into a brave new world, one with medicine bespoke for each
individual. The chapters I covered went into great detail about how this drive for
individualized medicine pulls resources away from critical components of public
health such as water access and education. In addition I discussed the impact of
medical experimentation upon lower income communities. Generally my
presentation was about how the individualization of medicine, and medicine in
general, favors those with greater access to capital.
I will take this blog post to elaborate upon many of the issues facing public
health today, and to argue (much like the text) that this drive is antithetical to the
proper function of medical institutions. Firstly I would like to illuminate, or
perhaps simply remind, the fact that 10% of individuals hold between 67-70% of
the wealth in our great nation.
(https://www.cbo.gov/publication/60807) (link)
This disparity, as shown, is increasing. The bottom 50% of Americans hold
only 2.4% of wealth. Another bright statistic is that (approximately) 735
billionaires hold more wealth than (approximately) 164.5 million people.
This leads to an issue I believe is antithetical to the American thesis of “life,
liberty and pursuit of happiness.” That issue being that as many as 65% of
bankruptcies are filed as a result of medical debt (PMID 30726124). In addition
healthcare costs continue to rise with a 5.1% increase in 2024 alone, easily
outpacing the 2.9% rise of inflation. If these costs continue to rise more Americans
will face the choice of ignoring a malady or potentially losing all they own.
The fact that this choice is allowed to occur is despicable to me. I think our
focus ought not be upon these hyper-specific treatments when countless Americans
cannot afford healthcare as it is. I don't mean to say technological advancement
should be entirely discarded, moreso that amelioration of the American people’s
suffering deserves the greatest attention. I firmly believe access to healthcare is a
fundamental human right. I also am uncertain how our nation is meant to uphold
those aforementioned tenets while simultaneously allowing such injustice to
continue unabated.
One may claim that programs such as Medicare and its corresponding Caid
serve to reduce this burden upon the average American, however medicare
reimbursement continues to lag behind inflation. The American Hospital
Association (AHA) states that between 2022 and 2024 general inflation rose 14.1%
while Medicare net impatient payment rates rose only 5.1%.
(https://www.aha.org/costsofcaring) (link)
This again is abhorrent, the erosion of public institutions for the benefit of
the few (most unfortunately) is a common trend nowadays. The AHA expands on
some issues facing hospitals, and as a result Americans, going on to say that
current tariffs could “exacerbate shortages, disturb patient care, and raise prices for
hospitals.” Also stating that 70% of medical devices marketed in the U.S. are
manufactured solely overseas (and subject to tariffs). One interesting statistic is
that China currently manufactures 94% of the plastic gloves utilized by our health
care providers.
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Now imagine for a second that you, dearest reader, have put forth such
pivotal research to a given field that you are awarded the Nobel prize. An honor
befitting a lifetime of furthering our species as a whole, a laurel without peer. (at
least in my eyes). After all this effort you have been seen by the highest authority
and have been deemed one of the greats. This is the story of Leon Lederman, a
Nobel laureate in the field of Physics and the discoverer of the Muon Neutrino
(some cool subatomic particle that I don't really know anything about). I will gloss
over much of his early life here, however He served in World War II prior to his
academic career . After his service he enrolled in Columbia University’s PhD
program graduating in 1951. Following this achievement he went on to become a
faculty member and eventually a full professor at the university in 1958. He would
later resign from the position in 1979, moving on to the Fermi National
Accelerator Laboratory outside of Colorado. He would receive his Nobel Prize in
1988. Despite his accolades he would continue to teach Physics, even making a
point to teach to non-majors at the University of Colorado. Much of his life after
leaving Columbia was devoted to educating the younger generations. He would go
on to found many institutions in order to further his goal of improving science
education.
Lederman celebrating his birthday with children from the FermiLab Daycare.
(https://www.aaas.org/news/memoriam-leon-lederman-life-awareness-joy-and-
curiosity) (link)
This man who had given his life wholly to those young souls who would
follow in his footsteps, who had served our nation in war and in peace, was thrown
to the wayside by the very nation he cared so dearly for. In 2011 the great
Lederman began to suffer from memory loss, and this great man began to lose
money quickly. The average day in a hospital costs $5,220 and in a nursing home
the costs are only higher. This bastion of intellect and servant of the people was
forced to sell the prize he worked so hard for to the highest bidder in order to
staunch the flow. The prize was sold for $765,000 in 2015.
(https://www.vox.com/health-care/2018/10/4/17936626/leon-lederman-nobel-
prize-medical-bills) (link)
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To me this story is a great shame upon our nation. How can we allow a man
who bettered so many lives to suffer such a fate. It is my firm belief that no one
should be made to fear the costs of healthcare. The only way forwards for public
health is for it to become MORE public. This focus upon DNA and tailor-made
solutions only serves to widen the already massive gap between the haves and the
have-nots. “Better” medicine does not matter if that betterment leads to a reduction
in accessibility. Our goal as future doctors, lawyers, and changemakers should be
to help as many people as we can. We may not turn the world on its head, but it is
my view that every individual leaves an indelible mark upon it. Do your best
comrades, I have truly enjoyed my time with you all. Amor Vic Omnia.
David
The Ethical and Social Dimensions of Reproductive Tourism
In recent decades, reproductive tourism—also referred to as cross-border reproductive care (CBRC), or procreative tourism—has grown into a significant global phenomenon. As assisted reproductive technologies (ART) become more widely accessible, individuals and couples from a range of socioeconomic and cultural backgrounds increasingly travel across national borders in search of fertility treatments that may be unavailable, unaffordable, or restricted in their home countries.
Evolving Demographics and Market Dynamics
One of the most striking developments in the reproductive tourism industry is the increasing participation of individuals in the 45–54 age group. According to market research, this demographic segment is expected to grow at the fastest compound annual growth rate (CAGR) in the foreseeable future. This trend is attributed to a number of converging factors, including higher spending capacity, increased financial stability, and the widespread availability of advanced reproductive technologies in developed nations (Fertility Tourism Market Size & Share Report, 2022-2030).
Furthermore, societal attitudes toward late parenthood are undergoing a significant transformation. Historically, having children later in life was often stigmatized or viewed as biologically risky. However, growing cultural acceptance and shifting norms have led to broader social approval of parenthood beyond the traditional childbearing years. With fewer social penalties and better medical support, older individuals now feel more empowered to pursue parenthood through ART.
Additionally, the globalization of healthcare has had a profound impact on the accessibility and attractiveness of cross-border reproductive services. Fertility clinics in countries like India, Ukraine (prior to recent geopolitical shifts), and Greece offer cutting-edge treatment at competitive prices, appealing to prospective parents from countries where such procedures are cost-prohibitive or heavily regulated. These global inequalities in cost and availability have given rise to a lucrative and increasingly complex fertility tourism market.
Ethical Tensions in Cross-Border Reproduction
Despite the hopeful narratives that often accompany stories of cross-border surrogacy and IVF success, reproductive tourism is rife with ethical dilemmas. One of the most pressing concerns is the economic exploitation of women from low-income countries. Surrogate mothers are often recruited from economically disadvantaged backgrounds and may lack access to comprehensive information, legal protection, or psychological counseling.
Anastasiadou et al. (2023) underscore these risks, pointing out that surrogate arrangements frequently occur in countries with weak regulatory frameworks. As a result, surrogate mothers can become instruments in a process that prioritizes the desires of wealthier, often Western, intended parents. These arrangements raise profound questions about consent, autonomy, and human dignity: is the surrogate acting freely, or is she compelled by financial desperation?
Echoing this concern, Igareda Gonzalez (2020) argues that surrogacy can be perceived as an affront to human dignity because it commodifies the human body—treating the surrogate not as an end in herself, but as a means to someone else’s reproductive goals. This instrumentalization of women’s bodies is deeply troubling in ethical frameworks grounded in human rights and bodily integrity.
In some cases, the transactional nature of international surrogacy can even verge on child trafficking. When children are produced through financially-driven arrangements lacking transparent regulation and oversight, there is a legitimate fear that they may be treated as commodities rather than individuals with rights and protections. The presence of money in these arrangements, especially when crossing borders and jurisdictions, complicates the moral landscape and intensifies concerns about exploitation and coercion.
Legal and Regulatory Challenges
The legal inconsistencies surrounding reproductive tourism further exacerbate these ethical issues. While some countries have clear legal frameworks supporting or prohibiting surrogacy and ART, others lack any regulation, creating legal limbos that can leave all parties—intended parents, surrogates, and children—vulnerable. In such a fragmented global landscape, it becomes difficult, if not impossible, to monitor professional medical standards, enforce informed consent protocols, or ensure independent counseling for surrogate mothers (Anastasiadou et al., 2023).
Additionally, legal parenthood is not universally recognized across borders. A child born via surrogacy in one country may not automatically be recognized as the legal offspring of the intended parents in their home country, leading to complications in citizenship, custody, and parental rights. These legal gray zones can result in situations where children are left stateless or separated from their intended parents.
Even in cases where intended parents and clinics act in good faith, the lack of consistent legal frameworks poses considerable challenges. Without international agreements or regulatory harmonization, reproductive tourism operates in a patchwork of laws that can undermine accountability and ethical responsibility.
Cultural Contexts and Human Rights Considerations
It is also important to consider how cultural perceptions of family, motherhood, and reproduction shape and are shaped by reproductive tourism. In some cultures, infertility carries significant stigma, making ART and surrogacy emotionally and socially charged decisions. For many, cross-border reproductive care offers a path to parenthood that avoids local judgment or legal barriers. However, this also means that surrogacy often occurs in secrecy, obscuring the emotional and psychological toll on all parties involved.
Moreover, gendered expectations around motherhood and caregiving are reinforced in reproductive tourism practices. The global surrogacy industry disproportionately relies on women from lower socioeconomic classes to perform reproductive labor, thus perpetuating global inequalities in gender and class. This echoes broader critiques of the global care economy, where the reproductive labor of marginalized women sustains the lifestyles of wealthier populations.
From a human rights perspective, the challenge is to balance the reproductive rights of individuals with the rights and welfare of surrogates and children. Reproductive autonomy is a critical freedom, yet it must be exercised within an ethical framework that upholds the dignity, safety, and agency of all involved parties.
Moving Toward Ethical Reform
As the market for reproductive tourism continues to grow, so too must the international community’s efforts to address the legal and ethical challenges it presents. Scholars, policymakers, and human rights advocates must work collaboratively to establish guidelines that ensure informed consent, fair compensation, legal clarity, and emotional support for surrogate mothers. The creation of international protocols or agreements—similar to those governing adoption or organ transplantation—may offer a path toward more ethical and transparent practices.
Additionally, increasing public awareness and promoting ethical consumer behavior among intended parents can help drive demand for higher standards and better protections. Ethical reproductive tourism must prioritize the well-being of all participants, not just the desires of those seeking to become parents.
Conclusion
Reproductive tourism sits at the intersection of medicine, globalization, economics, and human rights. While it offers powerful opportunities for individuals and couples to realize their dreams of parenthood, it also raises serious ethical and legal concerns that cannot be ignored. By critically examining the forces driving the industry and advocating for stronger oversight and protections, we can move toward a model of cross-border reproductive care that respects dignity, ensures justice, and safeguards the rights of all.
References
Anastasiadou, S., Masouras, A., & Papademetriou, C. (2023). Attitudes Toward Reproductive Tourism and Cross Border Reproductive Care (CBRC): Legal, Economic, Ethical Issues and Dilemmas, Possibilities and Limitations. Proceedings of the International Conference on Tourism Research (ICTR), 17–23.
Fertility Tourism Market Size & Share Report, 2022–2030. (n.d.). Grand View Research. https://www.grandviewresearch.com/industry-analysis/fertility-tourism-market-report
Igareda Gonzalez, N. (2020). Legal and ethical issues in cross-border gestational surrogacy. Fertility and Sterility, 113(5), 916–919. https://doi-org.ezproxy.mtsu.edu/10.1016/j.fertnstert.2020.03.003
The Innate Inferiority of Inmates
"You can monitor and control everything about them: their diet, their exercise, their sleep — everything about them,"
-Carl Elliot, author of The Occasional Human Sacrifice: Medical Experimentation and the Price of Saying No, 2024
Throughout medical history, countless transgressions have been made in the pursuit of scientific discoveries. To further their knowledge in the field, researchers would often find a shortage in willing participants for their studies. In light of this, they would frequently turn to those who would have little reason to turn down the promised benefits of research participation. Prisoners were commonly used as test subjects for a variety of experiments, including testicular transplants, radiation studies, live cancer injections, and psychotropic chemicals up until as recent as the late 1970s, when lawmakers began to crack down on such experimentation.
Prisoners were (and still are) seen as innately inferior in the eyes of researchers, easing the moral complications that they would otherwise feel when conducting questionable testing. Inmates are also much more susceptible to exploitation, having little other options in their confinement, often getting their sentence shortened or eased with their participation. For example, South Carolina inmates could have had their sentence shortened by 180 days if they agreed to become kidney donors, but that was turned down before it could be done. Unfortunately, multiple studies with much more questionable objectives were previously permitted. In this post, I will discuss three instances of prisoner testing, as well as what fundamentally changed to keep such atrocities from ever occurring again.
At the start of WWII, U.S researchers were tasked to find a way to effectively prevent contraction of STDs among soldiers who mingled with prostitutes. In 1946, experimentation began on about 5128 Guatemalans prisoners, sex workers, soldiers, children, and psychiatric patients. About 25% of these people were deliberately infected with STDs such as syphilis, gonorrhea, and chancroid, with all of them being experimented upon without their consent. The sex workers would spread the disease, with variants of penicillin being administered. One particularly horrific case was that of lead investigator Dr. John Cutler’s treatment of Berta, a female psychiatric patient who, in February of 1948, was injected with syphilis. A couple months after being introduced to the virus, Dr. Cutler noted the presence of lesions and dying skin. In response, he took gonorrheal pus from another male subject and injected it into both of her eyes, as well as her urethra and rectum. Four days later, she died. In 2010, President Barack Obama issued an apology on behalf of America to the Guatemalan people, but I firmly believe no words could suffice in making up for the horrendous and unnecessarily cruel acts of the American people.
Later during WWII, malaria became a pressing issue. With US soldiers being deployed in areas of the Pacific with dramatically high rates of infection and factories of therapeutic medication being captured by the Japanese navy, the army was in dire need of an alternative solution. General Douglas MacArthur reportedly exclaimed:
“Doctor, this will be a long war if for every division I have facing the enemy I must count on a second division in hospital with malaria and a third division convalescing from this debilitating disease!”
In an attempt to mitigate this growing problem in the army, studies were conducted. At the Stateville Penitentiary in Illinois, prisoners were administered bites from infected mosquitos and later given a variety of 8-aminoquinoline compounds, commonly used to treat malaria, in exchange for an earlier parole or shortened sentence. However, the prisoners acted as more than just research subjects in the study, they would record data, administer malarious mosquito bites and experimental drugs on each other, and would even decide who would participate in the study, as well as who receives the aforementioned sentence shortening. The prison in which this study was held was of a panopticon design, which provided researchers with the perfect opportunity to observe the prisoners at all times, but this would not save them from the outlier drugs. One 8-aminoquinoline variant, SN-8233, made three inmates extremely sick, quickly compromising their white blood cell count. After administering penicillin, one of the men seemed to improve. By morning, he was dead. The cause of death was heart failure.
Finally, from 1963 to 1971, a series of experiments were conducted by Carl Heller at various prisons through Oregon and Washington in the pursuit of understanding radiation’s effect on human reproduction as the downsides of space travel began to come into question. In the study, inmates would have their testes irradiated to determine how it would affect spermatogenesis, recovery of the cells, and hormonal effects. Multiple biopsies would be taken, as well as an eventual vasectomy. No warnings were given to the volunteers, with only the subtle mention of the possibility of tumors given several years into the experiment. There were, of course, no health benefits from participating in the study. There were, however numerous financial incentives for participation. Typically in the prison industry, inmates were paid 25 cents an hour. In the study, prisoners were given 25 dollars for each testicular biopsy, as well as a bonus $25 when they were vasectomized at the end of the program. Laws restricting the study began to go into effect in the early 1970s, so follow-ups on the irradiated subjects were never done. It is likely that several had run-ins with cancer later down the line.
So where does it all end? Well, at the conclusion of World War II, a ten-point system of principles known as the Nuremberg Code was devised after the discovery of the atrocities committed by Nazi physicians. This system mandated voluntary consent, lack of unnecessary injury, the ability of a subject to withdraw, and so on. With these statutes in place, further laws were soon passed to forbid studies as horrendous as the ones discussed.
It is truly disturbing to learn of the terrible things done in the pursuit of science, but it is necessary to learn from these events if we are to become better ethicists.
Discussion Questions:
Disregarding the ethical concerns surrounding prisoner testing, do you think it is fair to lessen one's sentence for their inclusion in a study?
Do you believe children should be tested upon in any circumstance?
Would you participate in the malaria drug study if it meant shortening your sentence by a year? 5 years?
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