Do we really need more drugs? We can gain some insight into this question by posing a qualifying question: “How’s it working out so far?” The answer is rather obvious: “Not all that well.” Despite spending $2.5 trillion in 2009 on health care, representing almost 18% of our gross domestic product, the life expectancy of Americans ranks #36 worldwide. Numerous developing nations enjoy longer lifespans than we do. (Costa Rica, for example, ranks #30.) On the other end of the spectrum, the New York Times recently reported that the U.S. rate of premature births is comparable to that of developing nations. Regarding this impactful public health issue with long-term consequences for society, the U.S. does worse than any Western European country. The U.S. premature birth rate of 12% is comparable with that in Kenya, and Honduras. In other words, on this measure the overweening technological superiority of our notoriously costly health care system fares no better than that of countries with per capita incomes of $2 a day.

With respect to chronic disease, it is not unreasonable to assert that medical treatment has obtained equivocal results in the population. Statins are a drug class that has demonstrated proven benefit. For persons who have risk factors for atherosclerotic coronary artery disease, statin use effectively reduces the risk of death due to cardiovascular disease, including stroke. Benefits of statin use increases over time. But drug companies want to extend the statin hegemony to include persons at low cardiovascular risk. In other words, global pharmaceutical corporations want physicians to prescribe statins for prevention in otherwise healthy persons.

The year is 2029. After discussing schedules, I've picked early afternoon April 28 as my day. That works for most of us. My wife will have returned from her conference. My sisters can fly in after their dance recital. My brother rescheduled his interviews.

Cousins can drive in from the coast. Some nieces and nephews can't make it, but that's all right. They're busy. Dr. Landis assured us it would be brief. I'll just take the pill the good doc gives me and fall quickly asleep, peacefully, forever. No pain. I'm doing what's right. It is better for all of us.

As we face dying's three dreads — pain, abandonment, helplessness — what is the practical allure of physician-assisted suicide?

“A call to arms” may be a bit martial for many bioethicists, but we live in perilous times. Meaningful action is needed across the board with respect to the functioning of government, whether federal, state, or local. We are confronted with the effects of benighted policies (or lack of policies and lack of regulations) that threaten to destroy our national (and global) financial system, our national health care “system” (really a default hodgepodge of buyers, sellers, and canny middlemen), and our global ecosystem. Standards of living continue to erode in the U.S. and Europe. Unemployment persists at high levels. In the United States, at least, educational achievement is in free fall. We live in a national culture that has degraded to the narrow perspective of me and mine. It is not an exaggeration to assert that many Americans have lost their moral compass, if indeed they ever had one. For the rest of us, those who recall what it means to be blessed with the right to life, liberty, and the pursuit of happiness, it is long past time to do what anchorman  Howard Beale did in Network: throw open the windows to the street, lean our heads out, and shout I’m mad as hell and I’m not going to take this anymore!

The Alden March Bioethics Institute offers graduate online masters in bioethics programs. For more information on the AMBI master of bioethics online program, please visit the AMBI site.

In Fasil Tekola Ayele’s native Ethiopia, the people call it “mossy foot.” Medical textbooks call it podoconiosis, non-filarial elephantiasis, or simply “podo.”

The hideously deformed feet of podo result not from mosquito-borne parasitic worms, as does filarial elephantiasis, nor from bacteria, like leprosy. Instead, podo arises from an immune response to microscopic slivers of mineral that penetrate the skin of people walking barefoot on the damp red soil that tops volcanic rock. Podoconiosis means “foot” and “dust” in Greek.

The Alden March Bioethics Institute offers graduate online masters in bioethics programs. For more information on the AMBI master of bioethics online program, please visit the AMBI site.

Something remarkable is happening in the world of medicine (the field is often considered a monolithic special interest group). On April 4, 2012, nine medical specialty societies released lists of the "Top Five" services that are the most expensive and "have been shown not to provide any meaningful benefit to at least some major categories of patients". These nine lists are the first results of the "Choosing Wisely" campaign, launched by the American Board of Internal Medicine in response to a 2010 article in the New England Journal of Medicine.

That article challenged physicians to take the lead in health care reform. Rather than waiting for the government to impose new standards and regulations, the article encouraged physicians and professional medical societies to identify wasteful services and procedures that could be readily eliminated.

Scientists now have the capability of changing the world. Literally. A prominent researcher observed in a 2011 Science article that "our genome engineering technologies treat the chromosome as an editable and evolvable template". The advent of such technologies is disturbing from many points of view.

Until very recently scientific research contributed to the advancement of knowledge about the world around us without simultaneously creating tools for altering the characteristics and parameters of that world. None of these activities threatened the integrity of the biosphere — namely, that of planet earth. The ability to do so should give all of us, primarily scientists, pause, but they do not. As Hans Jonas observed, the deeds of biological engineering are irrevocable.

The Alden March Bioethics Institute offers graduate online masters in bioethics programs. For more information on the AMBI master of bioethics online program, please visit the AMBI site.

Last week's historic three days of arguments before the Supreme Court on the merits of the Affordable Care Act provided many head-scratching moments. Those naive enough to believe that the case was actually going to be considered on constitutional grounds (this being the Supreme Court, after all) were rudely awakened to an apparent actual agenda of partisan politics and corporate interests.

Broccoli was a key theme, startling the 50 million Americans who may be able to purchase green vegetables at the local market but are unable to purchase badly needed health insurance. The welfare of health insurers was a second prominent theme, providing concrete evidence to those who posit that our nation is no longer a government of the people, but rather a "government of the corporation".

The outrage has been profound, including Op-Ed pieces in The New York Times, featured articles in The New Yorker, and commentary in the New England Journal of Medicine.

First, the produce. During the second day of arguments, Justice Scalia attempted to define the market for health care. He said ". . . you define the market as food, therefore everybody is in the market; therefore, you can make people buy broccoli." Chief Justice Roberts picked up the theme as easily as if he were choosing a ripe cantaloupe at his local farm stand. Roberts informed us that "a car or broccoli aren't purchased for their own sake, either." Broccoli is purchased to cover the need for food, we were sagely advised.

The Alden March Bioethics Institute offers graduate online masters in bioethics programs. For more information on the AMBI master of bioethics online program, please visit the AMBI site.

It has been a very busy week at the Supreme Court. Three days of arguments on the various challenges to the Patient Protection and Affordable Care Act each merited front-page coverage in The New York Times. SCOTUSblog, the blog of the Supreme Court, received more than 800,000 hits in three days, which was more than the site has received in its first 4 years of existence. Regardless of the court's final ruling (expected on June 28th), the active engagement in our robust democratic politics of so many Americans and interested parties worldwide bodes well for the future of our way of life. Separation of powers, first described and promulgated by John Adams (second president of the United States) in his treatise, Thoughts on Government, Applicable to the Present State of the American Colonies, is alive and well.

It's easy to experience the ebbing of America's power. Our national political scene is a toxic partisan shambles. We have been severely depleted — our blood and treasure have been unthinkingly squandered in 10 years of geopolitically useless war in Iraq and Afghanistan. We are beset by real threats to our welfare and continued existence . . .

The Alden March Bioethics Institute offers graduate online masters in bioethics programs. For more information on the AMBI master of bioethics online program, please visit the AMBI site.