Monday, June 27, 2005

Hey buddy, can you spare 200 grand?

People always say that money can't buy happiness. And I agree. But did you know that it can buy you life? Don't believe me? Take for instance the recent Terry Schiavo case in Florida. Terry had a great healthcare plan. Full coverage. Fifteen years of excellent medical care and not a single bedsore. In contrast, consider the Texas family of a 6-year boy who was taken off of life support over the objections of his parents, in large part because of their inability to pay for his healthcare. Apparently in some cases, money is life.

Lately I've been trying really hard to grapple with the fact that money is essentially what drives all of our lives, what we do each and every day, and in a very large way, whether we'll live to see another sunrise. We humans have more capabilities to save and improve lives than at any other time in history. Discovering a treatment or cure for just about any medical issue is a matter of time and money. We've been throwing tons of cash at heart disease and cancer for over half a century and we've made tremendous advances. I'm convinced that now is the time to throw that same effort into neurological disorders, and not just because I happen to have one.

But scientific research requires an enormous amount of money, averaging about $62 per minute. As I mentioned in a recent post, our government has already spent more money on the war in Iraq than on research and treatment for all diseases combined in the previous decade. Perhaps people against the war aren't really fans of Saddam or the terrorists after all, as some idiots have suggested (ahem, Karl Rove). Perhaps they're just asking "at what cost?", both in terms of money and lives. Minnesota's share of the bill for the Iraq war in 2004 came to $4.7 billion. That money could have provided healthcare for 608,587 people last year. Seems to me our country's priorities aren't as aligned with our 'moral values' as we like to think they are. The war in Iraq really boils down to managing hypothetical risks. Managing the risks of terrorism and the control of the middle east oil supply. I am not at risk of getting ALS. I already have it. As do the millions of people in this country fighting their own wars against a myriad of illnesses.

You may be wondering about the 200 grand reference in the title of this post. That is the estimated amount of money a family has to pay annually for the healthcare of a loved one in the late stages of ALS. 200 grand. Per year. Do you have 200 grand? 'Cause I don't have 200 grand. And we're talking the bare minimum of care here folks. You want a van with a wheelchair ramp? 40 grand. A lift in your house? 10 grand. These things aren't covered by any healthcare plan, much less Medicare/Medicaid. I've been a hard working taxpayer since I was 14 years old, and now I have a disease (one that I did nothing knowingly to cause) that could take everything I've worked for away from me. But I'm not as concerned for myself as for others, who don't have good health insurance, who don't have a good network of family and friends. I recently read about a woman bedridden with MS in Alabama say that every month she has to choose between food and medication.

ALS is, like many other illnesses, considered an "orphan disease", meaning less than 200 thousand people are living with it in the U.S. And like an orphan, such diseases tend not to feel very much love, especially in terms of government funding. Our government spends less than 400 dollars a year on a person with ALS. By contrast, even though only 20-40% more people are diagnosed with MS as with ALS every year, MS receives 10 times the amount of federal money. Makes sense though. MS patients live longer, so there is a larger patient population to lobby for money. Aha! A larger population also means more potential profit for drug companies, which is why so few companies bother to consider research for a targeted ALS drug. Rilutek is the only drug approved for ALS, and even though it doesn't do a heck of a lot to slow the disease, it still costs about $11,000 a year, and provides roughly $100 million annually to its maker. That may seem like a good chunk of money, but in the big business of pharmaceuticals, it's chump change. As I said, it's about the money. What it boils down to is that curing my illness simply isn't worth the investment by the free market (see my recent posts about government funding of stem cell research). Families dealing with an orphan disease have to beg.

But what if a drug was developed that significantly extended the life of a person with ALS? The longer we live, the more of us there are, and the more money to be made. Seems to me we PALS ('Persons with ALS') are an untapped market, with potential to make some serious cash for a willing investor. As my friends at ALS TDF like to talk about, I'd love to help make a drug company billions of dollars. Just give me that chance. But drug companies see more dollar signs in drugs that get you off, not ones that get you well.

Yep. I've joined one of the most undesirable clubs in history. Roughly 30,000 people in the U.S. have ALS at any given time, with 5600 to 8000 new cases diagnosed every year. Initially I thought that 30,000 seemed really small, but when you consider that 80% of those with ALS die within 5 years, you realize that it affects far more people (not to mention their families) than the numbers suggest. And the numbers are vague because of the wretched ways we track disease in this country. Quite often ALS doesn't show up on a death certificate. A person with ALS who dies during a fight with pneumonia still died because of ALS. But if we consider the numbers going back say, 50 years, they suggest that upwards of 400,000 people have lived and died with ALS, about the same number of Americans killed in World War II. Granted, that's me doing some bar napkin math, but the numbers are still compelling. Like a war, ALS kills people rather quickly. Imagine how many lives we'd save if we invested more time and money into preventing both of them.

And that's really my point here folks. The more I learn about how we spend our money in this country, the more I see priorities out of whack with the supposed moral values we like to pat ourselves on the back for. We like to think that we give the most of any country to the rest of the world and ourselves. But did you know that, per capita, we are 18th in the world in charitable giving? That includes government, corporate, and private giving. We're one of the wealthiest and most powerful countries on the planet, and we give the same amount of money per person as Australia. That really chops my hide. No offense to my friends down under. And props to my ancestors in Norway, who give the most of any country.

Don't get me wrong. I'm proud to be an American. I love my country deeply, and I feel incredibly fortunate to have been born here. And frankly I'm sick of seeing people have to defend their patriotism when pointing out a potential opportunity for improvement, but that's another story. We do indeed give a great deal of our time and money to help others. But let's face it, most of us would rather focus on building our own fortunes, having our own fun, watching our favorite sports teams lose over and over, and finding out if Michael Jackson is a felony convict kind of freak, or just a plain freak. And sometimes rightly so. It's hard work, physically and emotionally, to focus on the hardships of the world. But if there is one quality Americans have uniquely proven to have, it's our ability to pull together as a team, not take 'no' for an answer, and overcome insurmountable odds to make the world a better place. Perhaps that spirit will ultimately win out in Iraq. I hope the gamble will be worth it.

As for me, I'd rather see more focus on solving the immediate problems our families are facing: illness, disease, disability, pain, suffering. And not only a focus on the research to keep us alive, but on improving the quality of our lives. ALS will likely kill me. But it's entirely possible to live with it, if the right tools are available. The 2 to 5 year average death from the time of diagnosis is largely based on respiratory failure. It doesn't include, for those that choose such intervention, the time you can live using a ventilator. If you survive all the other perils until that point, you will essentially die either by accident, or by choice. But it costs a great deal of money to live that way. Equipment, 24/7 nurse care, you name it. As an inspiring ALS patient said to his friends and family, I'd be perfectly willing to be a 'brain in a box'. Just give me that chance.

I'm not just advocating for ALS. I'm talking about all diseases. All healthcare issues. And I ask you, the next time you're frustrated and complaining about taxes, please consider that at least a portion of them are going to help people like me. But a whole lot more are going to pay for bombs. Amidst the media circus surrounding the Schiavo case, a Republican proclaimed on the Senate floor, "the true measure of a country is how well it takes care of its poor, its needy, its underprivileged". A true measure indeed.

Friday, June 10, 2005

Episode III: Revenge of the Sick

Dear Senator Coleman,

Thank you for your prompt response with the boilerplate Bush administration policy on stem cell research. Please pass along my thanks to the aid who sent the actual reply. I certainly wasn't expecting you to respond personally. I'm fine with the fact that this is how communication with our politicians operates. But I must say I was disappointed to see the 'cloned' Republican response (pun very much intended), quoted verbatim, without any personal insight. An issue as important as this requires a great deal of discussion, analysis, and soul searching. None of us should consider it lightly, as I am sure you would agree.

As to the specifics of your response, I have several points to address.

You rightfully state that embryonic stem cell research is in its infancy, and I fully recognize that the benefits of this research may very well not be realized before I die. But I fail to see how that is a valid reason for not pushing forward now. Regardless of whether the promise is satisfied, we should do all we can, immediately, to determine if lives can be saved. To do otherwise betrays those of us alive today.

You also correctly state that President Bush is the first president to fund embryonic stem cell research, at what you call 'record levels'. You don't lie, but you fail to point out that scientists have only been able to do experiments with human embryonic stem cells (hESC) since late 1998. If such research is in its infancy now, it was barely 'embryonic' during the final term of Bill Clinton, the only president who could have funded it before. But the cat was already out of the bag at that point anyway. The NIH had a protocol in place for such research, and the President's policy vetoed it. I can hardly give President Bush credit for his actions when he has severely limited the government's support of a vital new avenue for saving lives.

The Bush administration policy does indeed allow for unlimited federal funding of research using stem cell lines existing before August 2001. But I ask you, why hasn't the President proposed any bills to actually fund what even he admits may save millions of lives? I say: show me the money. California did, so why not Capital Hill? Private sector funding amounts to a drop in the bucket compared to the typical research funding provided by the government. Academic institutions overwhelmingly rely on federal funds. Without them, my family and the families affected by all the other "orphan" diseases are left to beg for help on the street. Wall Street that is. But if the government isn't fully behind it, the free market simply won't cover the tab.

Furthermore, of the original embryonic stem cell lines available, only 22 remain viable for research. And as you mention, many of them are contaminated with mouse feeder cells, making them unlikely candidates for use in animal research, much less in humans. These 22 lines, even fully intact, are hardly "more than sufficient for basic research." Most doctors agree that it will not be long before the remaining lines are useless, and that we need to open up research on the over 150 identified potential lines available to us.

You note the director of NIH stating that contamination of existing lines will only matter when research is ready for human trials. Well aren't those trials inevitable if such therapy is ever to become useful? And while adult stem cells have certainly proved valuable and hold great potential for a variety of illnesses, even the NIH states that "Human embryonic stem cells are thought to have much greater developmental potential than adult stem cells. This means that embryonic stem cells may be pluripotent, that is, able to give rise to cells found in all tissues of the embryo except for germ cells rather than being merely multipotent, restricted to specific subpopulations of cell types, as adult stem cells are thought to be."

The bottom line, Senator Coleman, is that the current Bush administration policy is far too limiting for scientists to make significant progress in this arena. The policy panders to the left, by providing half-truths and relying on the convenience of stem cell lines created before President Bush was elected, while satisfying the far right electorate who put him office by supposedly sparing the "further destruction of human embryos that have at least the potential for life". What's next? A ban on masturbation? After all, sperm has that same potential doesn't it?

But I digress. The fact is, those same embryos the President claims to be saving are being destroyed anyway when a couple chooses not to use them for implantation. They can't become a child outside of a uterus. If the Bush administration wants to be consistent, why aren't they calling for a ban on in-vitro fertilization, which produces the excess embryos in the first place? If life is so precious, why did they rush to war with Iraq without expending all possible avenues of diplomacy as was promised? Why are millions of our own citizens without health insurance? I simply fail to see how the President has the moral high ground on matters of life and death.

But you are not President Bush. You are Senator Norm Coleman and you represent the needs of your state. You represent the needs of me and the thousands of us across the state who need your help. You have a tremendous opportunity to differentiate yourself on this and many other issues by doing what you feel is right. If you truly feel the current stem cell research policy is doing the job for me and others like me, so be it. But if you feel, as I do, that we should do everything we possibly can to save the lives of millions all over the world suffering from diseases for which embryonic stem cell research may one day provide a cure, then I ask that you reconsider your current stance and support the legislation coming before you.

As I've said, I am absolutely confident that one day the government will do the right thing on this issue. California has already taken a giant leap forward, and other Republicans are coming on board. In the meantime, myself and the millions of people fighting to stay alive will continue to press forward. And I will keep hope alive that you will act in time, so that perhaps I will live long enough to help my wife in raising my beautiful daughter.

Thank you for your time.

Sincerely,

Scott Stafne

As you may have surmised, above is the letter I sent back to Senator Coleman following his very PC response to my initial inquiry. Boilerplate as I called it. I love that word. Anyway, you may also have surmised that I'm very passionate about this issue. It is not an issue I consider lightly. As with abortion, I've struggled with all the related practical, moral, and emotional issues involved. When I was younger, I very much felt like the pro-choice movement, that the government should simply keep its hands off of women's bodies. And how dare they demand that a baby be born into a desperate situation while at the same time cutting funding for virtually every support program designed to help those babies? While that issue still exists and still frustrates me, I think I've turned over a new leaf since my daughter was born. I will not join any of the fanatical pro-life organizations who obviously fail to see the entire picture. But I know in my heart that I could never be a part of an abortion. I could never advise someone to take part in one either.

But embryonic stem cell research is quite different, and I hope you can see that difference too. While I'm sure they exist, I have yet to meet a single person with a disease such as ALS who doesn't feel the same. And I have a strong suspicion that if President Bush, Senator Coleman, or one of their children, were to find themselves in my situation, they would change their policies in a heartbeat. For those folks who disagree with my stance, I fully expect that they won't accept any of the cures that arise from embryonic stem cell research when they arrive. I fully expect they will deny treatment, and go quietly to their death.

Yeah right. I didn't think so.

Wednesday, June 08, 2005

Episode II: Attack of the Clone

Dear Mr. Stafne:

Thank you for taking time to contact me regarding stem cell research.

As you know, scientists are currently engaged in two basic types of stem cell research. One type is adult stem cell research. Adult stem cells are taken from fully mature cells, such as cartilage or bone marrow. The other type of research is embryonic, where the stem cells are taken from human embryos.

Both adult stem cell and embryonic stem cell research offer great promise.

Adult stem cell research, which does not have any real ethical problems associated with it, has already led to successful human treatment. For example, researchers have treated diabetic patients with islet cells from the pancreas of deceased human donors. More than 80 percent of those treated were able to stop their insulin shots for more than one year. Adult bone marrow cells have also been used to successfully heal chronic skin blemishes in patients. All of these human treatments use adult stem cells. No similar treatments have been developed using embryonic stem cells.

Advocates claim that embryonic stem cells have the potential to be used to treat and better understand numerous diseases. However, it is important to recognize that embryonic stem cell research is a relatively new science, which requires advanced skills and expertise. As policy makers, we must be careful not to oversell the science of embryonic stem cell research. The promise of embryonic stem cell research is very real, but it is still in its infancy.

President Bush's policy funds all types of stem cell research, both adult and embryonic. He is the first President in history to fund embryonic stem cell research, and he is doing so at record levels. Under the President's policy, all embryonic stem cell lines created before August 2001 are eligible for unlimited federal funding. This allows us to explore the promise and potential of stem cell research without crossing a fundamental moral line by providing taxpayer funding that would sanction or encourage further destruction of human embryos that have at least the potential for life. It is also very important to note that there is no limit on stem cell research or funding in the private sector.

It is my understanding that certain stem cell lines are contaminated with mouse feeder cells, making their therapeutic use for humans uncertain. If in fact these lines are contaminated, we should consider expanding the current federal policy on human embryonic stem cells in a vigorous and yet responsible manner.

According to Dr. Elias Zerhouni , Director of the National Institutes of Health (NIH), this is a safety concern, but this issue will be of practical significance only if and when embryonic stem cell research reaches the stage of human therapy trials. In the meantime, the lines currently available for use with the federal support are more than sufficient for basic research.

I appreciate your willingness to be a resource to my staff and me on this important issue. Thank you, once again, for contacting me. If I can be of any assistance to you in the future, please do not hesitate to contact me again.

Sincerely,
Norm Coleman
United States Senate

The above was the response I received from Senator Coleman's office, but certainly not from Coleman himself, as I received it about an hour after I sent my email to him. Rather it came from an assistant who copy/pasted the standard Bush administration policy response, further demonstrating Senator Coleman's cloned Republican policy. I'm too frustrated and upset by his reply to effectively respond, but I will soon. To be continued.

Sunday, June 05, 2005

Help me Obi Wan Kenobi, you're my only hope

Dear Senator Coleman,

My name is Scott Stafne. I am 33 years old and I have ALS (Lou Gehrig's disease). I have a wonderful wife and a brand new baby girl, and I desperately want to be there for both of them for as long as possible. Stem cell therapy, while unproven, holds perhaps the greatest potential to help keep me alive. Current government policy is far too limiting on stem cell research, and I simply don't have the time to wait for legislative paranoia and red tape to work itself out. I am convinced that eventually our government will do the right thing. I only pray they do it in time.

The federal government, as of last summer, has already spent more money on the war in Iraq than on funding research for all diseases, all illness, throughout the entire decade of the 90’s. What does that say about our values? Our priorities? I realize tanks, missiles, and ships cost a great deal of money, and I fully support our troops, but can you imagine how many more lives we’d save if we put the same money and energy into curing disease? Instead of building walls between ourselves and the rest of the world?

I also realize the ethical and moral dilemma posed by embryonic stem cell research. But I ask you, which is the immoral choice here? Allowing a couple to willingly donate material from their own bodies to help save lives? Or maintaining that the only option is to throw existing embryos in the garbage? An embryo is not a fetus. Like a stem cell, it merely has the potential to evolve into something greater. If my wife and I want to combine a part of ourselves in an effort to save my life, so I can be there for her, and for my daughter, what business does the government have in telling us no? As for the relation of cloning to embryonic stem cells, I fail to see why we can’t place restrictions on cloning and still allow research to go forward on finding treatment for disease.

I have never begged for anything in my life. But right here, right now, I swallow my pride and beg you, Senator Coleman, please give me a chance to live. Please give me hope. Please give hope to the millions of us with diseases like ALS. I ask that you join me and others in our state in the fight against Amyotrophic Lateral Sclerosis (ALS), by cosponsoring S. 471, the Stem Cell Research Enhancement Act of 2005 and urging the Senate leadership to schedule a vote on this important legislation. The House passed the companion bill to S. 471 on May 24 by a bipartisan vote of 238-194.

I trust you will receive numerous letters with boilerplate information about the current legislation, urging you to support it. But I’d rather leave you with one last question. If somebody you loved, a son or daughter, a mother or father, were to be diagnosed with ALS or another horribly incurable disease, wouldn’t you want to do everything in your power to give them a chance to live? A chance to hope? That is why I write to you today. I do not ask for myself. I ask for my wife. I ask for my daughter. And for the millions of families who need your help.

Most sincerely and respectfully,

Scott Stafne

The above is a letter I recently sent to the senators of Minnesota, urging their support for stem cell legislation. Regardless of how you feel about this issue, I encourage you to make your own voice heard. An easy avenue to do so is via http://capwiz.com/alsa/home/, where it takes about 5 minutes to send an email to the relevant legislators for your area. Even if President Bush vetoes this legislation, should it pass the Senate, there is a movement afoot. People are starting to become more informed, more aware, and more convinced than ever before that this avenue must be explored. It will inevitably happen in other parts of the world. We have the opportunity to make it happen right.