A September 28, 2013 www.cnn.com article entitled “In Cancer Drug Battle, Both Sides Appeal to Ethics” presented the case of an ovarian cancer patient who wanted to take an experimental drug — BMN 673 — that the relevant pharmaceutical company, BioMarin, declined to donate. Important additional information for an anarcholibertarian bioethical analysis of this scenario is the following: the patient was not eligible for any clinical trials evaluating the safety and/or efficacy of BMN 673; the patient was seeking use of BMN 673 via the Food and Drug Administration (FDA) “compassionate use” clause, by which the FDA permits a patient with few or no treatment alternatives to access an unapproved drug mired in the development process while simultaneously absolving the relevant pharmaceutical company of liability should the drug cause harm or not work; and pharmaceutical companies are not required to provide drugs requested under the “compassionate use” provision.

Why did BioMarin forgo the opportunity to donate BMN 673 to this particular patient? The corporation claimed it “would be unethical and reckless to provide end-stage refractory ovarian cancer patients outside a clinical trial with BMN 673 at this early stage of development”. Contrast this reply to the response of Mapp Biopharmaceutical, Inc. to requests for access to the experimental Ebola Virus Disease (EVD) drug ZMappTM, which I documented in a www.liberty.me article entitled “Enchanted Ebola Elixir”.

How did the patient and her representatives respond to BioMarin’s denial of their BMN 673 request? They asserted that it was unethical for the company to refuse to donate the drug to protect “its wallet at the expense” of her certain death. That’s a tad harsh. Donations, as ideally exemplified by Rose of Sharon breastfeeding a starving man at the end of The Grapes of Wrath, are non-obligatory. Was there any truth to, at least, the anti-greed portion of this screed? Maybe. The following is a logical argument consistent with the scorned patient’s view: BMN 673 is ridiculously expensive due to the onerous FDA regulation/drug approval process and the State-mandated intellectual property (IP) system, so BioMarin would lose a significant amount of money if it donated the medication.

Arthur L. Caplan, Ph.D. is the primary national bioethics “expert” interviewed for such tales. He delivered the mainstream bioethical view of this situation when he informed the reporter that “it’s too early in the process for a compassionate use exception for a different form of cancer than the one” BioMarin was targeting (breast cancer rather than ovarian cancer), especially because the drug could harm the patient, even “speeding her death”. With this statement, Dr. Caplan proved, at minimum, that he is an “expert” in paternalism.

Per usual, all parties entangled in this fiasco (BioMarin, the patient and her representatives, and Dr. Caplan) were wrong.  The anarcholibertarian analysis — the correct analysis — is as follows: BioMarin had no legal or ethical obligation to donate the drug to this or any patient, the patient and her representatives were wrong to claim that BioMarin acted unethically, and Dr. Caplan erred by imagining that his ends were the only just ends (“appropriate” donation timing determined by State functionaries).

What is the ultimate solution to this and similar bioethical dilemmas? Abolition of the State. Abolition of the State would markedly decrease the price of all medications (experimental or otherwise). The costs of compliance with FDA regulations and the IP system would immediately disappear, thereby liberating scarce resources so that willing sellers and buyers could more easily negotiate mutually satisfactory contracts. For example, in the BMN 673 scenario, absent a State, the scarce resources invested in production of this medicine would be much less, so BioMarin (assuming its motivation for not donating the medicine to the patient in this story was loss of scarce resources) would be much less likely to view such a donation as a prohibitive loss. But, the cynic replies, what if BioMarin, even in the absence of a State, chooses to not donate BMN 673 to a supplicant? Then we shall advocate vociferously, comrades, for this donation (which is what BioMarin should do, if only for pragmatic reasons, even in the presence of a State), yet reality is imperfect.

In conclusion, elimination of the State would eliminate the BMN 673 bioethical conundrum.