Taking Sides: Clashing Views in Health and Society

PART 1. The Health Care Industry

ISSUE 1. Will Managed Care Improve Health Care in the United States?

YES:: Gregg Easterbrook, from “How to Love Your HMO:: Managing Fine,” The New Republic (March 20, 2000)

NO:: Ronald J. Glasser, from “Flatlining:: The Coming Collapse of Managed Care and the Only Way Out,” The Washington Monthly (May 2001)

Journalist Gregg Easterbrook states that health maintenance organizations (HMOs) offer quality care and that high-quality medical care at an affordable price is not only possible under managed care—it is a reality. Pediatrician and author Ronald J. Glasser argues that managed care companies care more for profits than for people.

ISSUE 2. Should Life Sustaining Medical Care Be Rationed Based on Age?

YES:: Clare M. Clarke, from “Rationing Scarce Life-Sustaining Resources on the Basis of Age,” Journal of Advanced Nursing (2001)

NO:: Norman G. Levinsky, from “Can We Afford Medical Care for Alice C?” The Lancet (December 5, 1998)

Clare M. Clarke believes that rationing health care in old age has some merit and that the treatment of young people should be a priority. Norman G. Levinsky, a practicing physician, argues that health care should not be rationed by age and that age bias should be recognized and confronted.

ISSUE 3. Does Employer-Based Health Insurance Provide Adequate Coverage for Most Americans?

YES:: William S. Custer, Charles N. Kahn III, and Thomas F. Wildsmith IV, from “Why We Should Keep the Employment-Based Health Insurance System,” Health Affairs (November/December 1999)

NO:: Uwe E. Reinhardt, from “Employer-Based Health Insurance:: A Balance Sheet,” Health Affairs (November/December 1999)

Insurance and policy analysts William S. Custer, Charles N. Kahn III, and Thomas F. Wildsmith IV assert that the employment-based health care system in the United States offers a solid, proven foundation on which to base any reform, and that attempts to break the link between employment and health insurance coverage may greatly increase the number of uninsured Americans. Economist Uwe E. Reinhardt counters that, overall, the benefits of an employer-based health insurance system are outweighed by the problems, and that a new system could ultimately replace the current system.

ISSUE 4. Is the Pharmaceutical Industry Responsible for the High Cost of Prescription Drugs?

YES:: Christopher F. Koller, from “Prescription for Trouble:: Why Drug Prices Keep Exploding,” Commonweal (June 15, 2001)

NO:: Ronald Bailey, from “Goddamn the Pusher Man,” Reason (April 2001)

Christopher F. Koller, CEO of Neighborhood Health Plan of Rhode Island, a health plan serving Medicaid enrollees based in Providence, asserts that the pharmaceutical industry has achieved its rapid growth by political protection and by exploiting the vulnerabilities of patients. Ronald Bailey, science correspondent for Reason magazine, states that spending on prescriptions is rising rapidly because Americans are buying more drugs. Bailey maintains that the drug companies have actually enriched the quality of our lives.

PART 2. Health and Society

ISSUE 5. Is Drug Testing Vital to the Workplace?

YES:: William F. Current, from “Cut Costs and Increase Safety With Pre-Employment Drug Testing,” Occupational Hazards (July 2002)

NO:: Jacob Sullum, from “Urine—Or You’re Out,” Reason (November 2002)

William F. Current, president of WFC & Associates, a national consulting firm specializing in drug-free workplace policies, states that pre-employment drug testing is accepted by employees, hassle free, and beneficial to employers. Jacob Sullum, senior editor of Reason magazine, argues that employment-based drug testing is insulting to employees and mostly irrelevant to future job performance.

ISSUE 6. Should Doctors Ever Help Terminally Ill Patients to Commit Suicide?

YES:: Richard T. Hull, from “The Case For Physician-Assisted Suicide,” Free Inquiry (Spring 2003)

NO:: Margaret Somerville, from “The Case Against Physician-Assisted Suicide,” Free Inquiry (Spring 2003)

Richard T. Hull, professor emeritus of philosophy at the State University of New York at Buffalo, asserts that physician-assisted suicide is the only resource terminally ill patients have with which to communicate that their end-of-life care is inadequate. Margaret Somerville, Gale Professor of Law and professor in the faculty of medicine at the McGill University Centre for Medicine, Ethics, and Law in Montreal, Canada, argues that basic reasons to oppose euthanasia include the sanctity of human life and the harms and risks to individuals and to society. Somerville contends that these reasons outweigh any possible benefits.

ISSUE 7. Should the Government Regulate the Sale, Advertisement, and Distribution of Junk Food?

YES:: Marion Nestle and Michael F. Jacobson, from “Halting the Obesity Epidemic:: A Public Health Policy Approach,” Public Health Reports (January/February 2000)

NO:: Michelle Cottle, from “Heavy Duty,” The New Republic (May 13, 2002)

Marion Nestle, professor of nutrition, and Michael F. Jacobson, director of the Center for Science in the Public Interest, argue that a public health approach is needed to encourage Americans to eat a healthy diet. Writer Michelle Cottle contends that nonnutritious food should not be regulated any more than other unhealthy products. Cottle maintains that our relationships to food are too complex for the government to oversee.

ISSUE 8. Should Race Play a Role in the Treatment and Study of Disease?

YES:: Esteban González Burchard et al., from “The Importance of Race and Ethnic Background in Biomedical Research and Clinical Practice,” The New England Journal of Medicine (March 20, 2003)

NO:: Richard S. Cooper, Jay S. Kaufman, and Ryk Ward, from “Race and Genomics,” The New England Journal of Medicine (March 20, 2003)

Physician Esteban González Burchard and his colleagues contend that race should play a role in the treatment and study of disease since there is evidence that the risk of common diseases is determined by race-related genes. Medical researchers Richard S. Cooper, Jay S. Kaufman, and Ryk Ward argue that the potential for abuse is a reason to disregard race in genetic and medical studies. They also maintain that there is little evidence that the risk of most diseases is linked to race-related genes.

ISSUE 9. Should Embryonic Stem Cell Research Be Permitted?

YES:: Jeffrey Hart, from “NR on Stem Cells:: The Magazine Is Wrong,” National Review (April 19, 2004)

NO:: Ramesh Ponnuru, from “NR on Stem Cells:: The Magazine Is Right,” National Review (April 19, 2004)

Professor Jeffrey Hart contends there are many benefits to stem cell research and that a ban on funded cloning research is unjustified. Writer Ramesh Ponnuru argues that a single-celled human embryo is a living organism that directs its own development and should not be used for experimentation.

PART 3. Mind/Body Relationship

ISSUE 10. Should Addiction to Drugs Be Labeled a Brain Disease?

YES:: Alan I. Leshner, from “Addiction Is a Brain Disease,” Issues in Science and Technology (Spring 2001)

NO:: Sally L. Satel, from “The Fallacies of No-Fault Addiction,” The Public Interest (Winter 1999)

Alan I. Leshner, director of the National Institute on Drug Abuse at the National Institutes of Health, states that addiction to drugs and alcohol is not a behavioral condition but a treatable disease. Psychiatrist Sally L. Satel counters that labeling addiction as a chronic and relapsing brain disease is propaganda. Satel asserts that most addicts are the instigators of their own addiction.

ISSUE 11. Is Stress Responsible for Disease?

YES:: Editors of Harvard Health Letter, from “Can Stress Make You Sick?” Harvard Health Letter (April 1998)

NO:: Christopher Caldwell, from “The Use and Abuse of Stress,” The Weekly Standard (June 2, 1997)

The editors of the Harvard Health Letter maintain that there is evidence that individuals who are chronically stressed possess an increased risk of cancer and heart disease. Writer Christopher Caldwell argues that no one, including doctors, can come to an agreement on what stress is, so stress can not be blamed as the cause of disease.

ISSUE 12. Can Spirituality Overcome Illness?

YES:: Herbert Benson and Marg Stark, from Timeless Healing:: The Power and Biology of Belief (Scribner, 1996)

NO:: William B. Lindley, from “Prayer and Healing,” Truth Seeker (vol. 122, no. 2, 1995)

Herbert Benson, an associate professor of medicine at Harvard Medical School, and journalist Marg Stark contend that faith and spirituality will enhance and prolong life. William B. Lindley, associate editor of Truth Seeker, counters that there is no scientific way to determine that spirituality can heal.

PART 4. Sexuality and Gender Issues

ISSUE 13. Does Abortion Increase the Risk of Breast Cancer?

YES:: American Association of ProLife Obstetricians and Gynecologists, from “AAPLOG Statement on Induced Abortion and the Subsequent Risk of Breast Cancer,” Issues in Law and Medicine (2002)

NO:: Joyce Arthur, from “Abortion and Breast Cancer:: A Forged Link,” The Humanist (March/April 2002)

The American Association of ProLife Obstetricians and Gynecologists state that for any woman already pregnant, choosing abortion will leave her with a greater long-term risk of breast cancer than she would have if she were to complete her pregnancy. Joyce Arthur, editor of the Canadian newsletter Pro-Choice Press and abortion rights activist, contends that the assertion that having an abortion significantly increases a woman’s risk of breast cancer is deceptive and false.

ISSUE 14. Is Pre-Menstrual Syndrome a Medical Disorder?

YES:: Neil S. Skolnick and Harris B. Cohen, from “A Short Course on PMDD,” Contemporary OB/GYN (May 2004)

NO:: Stephen Ray Flora and Melissa Sellers, from “‘Premenstrual Dysphoric Disorder’ and ‘Premenstrual Syndrome’ Myths,” Skeptical Inquirer (May/June 2003)

Physicians Neil S. Skolnik and Harris B. Cohen maintain that pre-menstrual syndrome is a legitimate condition that may benefit from medical intervention and treatment. Stephen Ray Flora and Melissa Sellers argue that premenstrual syndrome is neither a mental disorder nor physical disease. They believe it is a normal part of life and should be treated as such.

ISSUE 15. Should Pro-Life Health Providers Be Allowed to Deny Prescriptions on the Basis of Conscience?

YES:: Katherine Dowling, from “Prolife Doctors Should Have Choices, Too,” U.S. Catholic (March 2001)

NO:: Adam Sonfield, from “New Refusal Clauses Shatter Balance Between Provider ’Conscience’, Patient Needs,” The Guttmacher Report on Public Policy (August 2004)

Physician Katherine Dowling asserts that prolife medical professionals are being pushed in directions that are in conflict with their beliefs. Journalist Adam Sonfield disagrees and claims that the conscience of prolife health providers can be in conflict with the legitimate medical needs of their patients.

PART 5. Public Health Issues

ISSUE 16. Is Gun Control a Public Health Issue?

YES:: Josh Sugarmann, from “Reverse Fire,” Mother Jones (January/February 1994)

NO:: Don B. Kates, Henry E. Schaffer, and William C. Waters IV, from “Public Health Pot Shots:: How the CDC Succumbed to the Gun ‘Epidemic,’” Reason (April 1997)

Josh Sugarmann, executive director of the Violence Policy Center, an education foundation that researches firearm violence and advocates gun control, argues that guns increase the costs of hospitalization, rehabilitation, and lost wages, making them a serious public health issue. Attorney Don B. Kates, professor of genetics Henry E. Schaffer, and William C. Waters IV, a physician, counter that most gun-related violence is caused by aberrants, not ordinary gun owners.

ISSUE 17. Should Parents Be Allowed to Opt Out of Vaccinating Their Children?

YES:: Barbara Loe Fisher, from “Should Parents Be Allowed to Opt Out of Vaccinating Their Kids? Yes,” Insight on the News (April 24, 2000)

NO:: Steven P. Shelov, from “Should Parents Be Allowed to Opt Out of Vaccinating Their Kids? No,” Insight on the News (April 24, 2000)

Barbara Loe Fisher, cofounder and president of the National Vaccine Information Center, states that parents should have the right to make informed, voluntary decisions about vaccination and that the government should not have the right to force the issue. Pediatrician Steven P. Shelov maintains that it would be poor public health philosophy and practice to consider not immunizing children against infectious diseases.

ISSUE 18. Does Anabolic Steroid Use Cause Serious Health Problems for Athletes?

YES:: Steven Ungerleider, from “Steroids:: Youth at Risk,” The Harvard Mental Health Letter (May 2001)

NO:: Dayn Perry, from “Pumped-Up Hysteria,” Reason (January 2003)

Clinical psychologist Steven Ungerleider asserts that anabolic steroids are dangerous to the health of athletes and should not be used. Freelance writer Dayn Perry states that the health risks of anabolic steroids are greatly exaggerated and that they pose limited harm to athletes.

ISSUE 19. Is Marijuana Safe Enough to Be Legalized?

YES:: Ethan A. Nadelmann, from “Reefer Madness 1997:: The New Bag of Scare Tactics,” Rolling Stone (February 20, 1997)

NO:: Eric A. Voth, from “Should Marijuana Be Legalized as a Medicine? No, It’s Dangerous and Addictive,” The World and I (June 1994)

Ethan A. Nadelmann, director of the Lindesmith Center, a New York drug policy research institute, asserts that government officials continue to promote the myth that marijuana is harmful and leads to the use of hard drugs. He states that the war on marijuana is being fought for purely political, not health, reasons. Eric A. Voth, medical director of Chemical Dependency Services at St. Francis Hospital in Topeka, Kansas, argues that marijuana produces many adverse effects and that its effectiveness as a medicine is supported only by anecdotes.

PART 6. Consumer Health

ISSUE 20. Does Multiple-Chemical Sensitivity Pose a Serious Health Threat?

YES:: Paul Yanick, Jr., from “Multiple Chemical Sensitivity:: Understanding Causative Factors,” Townsend Letter for Doctors & Patients (January 2001)

NO:: Stephen Barrett, from “MCS:: Mis-Concern Serious,” Priorities for Health (vol. 11, no. 1, 1999)

Journalist Paul Yanick, Jr. states that a condition known as multiple-chemical sensitivity is becoming one of our greatest health challenges. Psychiatrist Stephen Barrett argues that multiple-chemical sensitivity is an ill-defined problem and that no scientific test has ever provided evidence that it has an organic basis.

ISSUE 21. Is the Atkins Low-Carbohydrate Diet a Valid Weight-Loss Plan?

YES:: Gary Taubes, from “What If It’s All Been a Big Fat Lie?” The New York Times Magazine (July 7, 2002)

NO:: Michael Fumento, from “Big Fat Fake:: The Atkins Diet Controversy and the Sorry State of Science Journalism,” Reason (March 2003)

Journalist Gary Taubes asserts that eating fatty meats, cheeses, cream, and butter is the key to a long, healthy life. Michael Fumento, senior fellow at the Hudson Institute, argues that there are ample studies that dispute the benefits of a high-fat, low-carbohydrate diet.

ISSUE 22. Are Organic Foods Healthier?

YES:: Tony Farrell, from “Organically Yours:: Good for the Planet, Good for You,” Vegetarian Times (September 2003)

NO:: John J. Miller, from “The Organic Myth:: A Food Movement Makes a Pest of Itself,” National Review (February 9, 2004)

Journalist Tony Farrell maintains that organic fruits and vegetables may be more nutritious than conventional produce. Writer John Miller claims that organic farming is inefficient, organic foods may be contaminated with harmful bacteria, the whole process is not sustainable, and organic foods are no healthier than conventionally grown food.