"I really love the work," Professor emeritus Alan Wertheimer says of his post-UVM career at the National Institutes of Health where he's influencing the national debate on health care reform. "I have great colleagues who are very smart and very lively...Plus, there's no grading." (Photo: Jon Reidel)

When professor emeritus Alan Wertheimer retired in the spring of 2005 after 37 years in the political science department, the plan was to travel and relax in his new condo on the Burlington waterfront. Co-writing research papers with one of President Barack Obama's top health care advisers, a venture that would place him in the middle of a heated national health care reform debate, wasn't part of the retirement picture.

Wertheimer's plans changed almost immediately when he accepted a one-year visiting scholar position at the National Institutes of Health. One year later he joined the faculty as a senior research scholar in the department of bioethics in the Clinical Center of the NIH in Bethesda, Md. He was soon penning research papers with Obama's special health care adviser, Dr. Ezekiel Emanuel, a prominent bioethicist at Harvard and the NIH, who is also the brother of White House Chief of Staff Rahm Emanuel and Hollywood super agent Ari Emanuel.

An article written by Wertheimer, Emanuel and NIH pre-doc Govind Persad in the January of 2009 edition of The Lancet, a leading worldwide medical journal, titled "Principles for Allocation of Scarce Medical Interventions" has come under scrutiny for its advocacy of an alternative allocation plan called the Complete Lives System. Critics of Obama's health care plan seized on specific aspects of the system, including a sentence stating that the system "prioritizes younger people who have not yet lived a complete life, and also incorporates prognosis, save the most lives, lottery, and instrumental value principles."

The article, which is currently a hot item on right-wing blogs, is one of a few scholarly pieces that unexpectedly thrust Wertheimer into a somewhat significant role in the national health care debate, due in large part to his relationship with Emanuel, who has become the focal point of attacks from those opposed to Obama's national health care plan. "Alan sent me an email saying 'better you getting blasted than me,'" recalls Emanuel with a laugh.

"I had no idea that this is what I'd be doing after I retired," says the 67-year-old Wertheimer. "But I really love the work. I have great colleagues who are very smart and very lively. The departments are very congenial and interactive. Plus, there's no grading."

Reducing complex ideas to a sound bite

The controversial article in The Lancet explains that the system isn't an algorithm, but a framework that expresses widely affirmed values including priority to the worst-off, maximizing benefits, and treating people equally. "To achieve a just allocation of scarce medical interventions, society must embrace the challenge of implementing a coherent multiprinciple framework rather than relying on simple principles or retreating to the status quo," it concludes.

Wertheimer points out that the paper focuses on pandemic-related issues like flu vaccines, ventilators, and in some cases, vital organs. "We're not interested in the general allocation of medical resources, yet this is where a lot of criticism came up," says Wertheimer. "So we get hit there for arguing for our Complete Lives System view that tilts toward the young, rather than those who have already lived a relatively complete life, which to some extent is where the death panel crap came up. They say 'ya know, Emanuel and Wertheimer don't want to give resources to old people. Well, we're not talking about Medicare to the elderly."

Wertheimer and Emanuel say that when people in town meeting-type gatherings are confronted with specific situations like flu vaccines, ultimately they would say with great regularity that vaccines should go to their grandchild instead of them. "Now it's not clear that they were saying give it to anybody's grand-kid," says Wertheimer, "but the idea of giving the vaccine to a younger person didn't seem bizarre at all. In principle, they were sympathetic."

"As the current health care controversy shows, it's difficult to explain in a sound bite the philosophical and ethical issues presented in a lengthy research paper and how they relate to certain principles," says Emanuel. "One of the papers was two years in the making and another took a year, so we're pretty careful before we put one out. We may not have it perfect, but I think we have it better than anyone had it before. Our current level of academic rigor wouldn't have happened without Alan. We've pushed each other harder in that area. He's been a fantastic addition to our department and is a big hit in the bioethics community."

Producing research with public policy implications

One of the tougher issues Wertheimer has grappled with in his new position is the idea that his research could affect people's lives if it became public policy. "I have been very comfortable in the ivory tower," he says. "I do my scholarship and my philosophical work and never cared much if it had any impact on public policy. I was interested in getting certain philosophical arguments right and wanted to make a scholarly contribution if I could. But a lot of my colleagues, like Zeke, really want to have an impact on policy. To be honest, I find the whole idea sort of threatening. I mean what if we're wrong?"

Emanuel says he sees it as more of a personality difference. "I'm a little more confident that I'm more right than the alternative, where Alan is less dogmatic almost to a fault," he says. "He'll preface a comment with 'I may be wrong about this, but...' even though it's a usually a brilliant idea."

Wertheimer's current research contains some of the same elements as the work he did at UVM on the political philosophy of law, including making ethical decisions and consent and coercion in sexual relations, exploitation, and criminal defense. His forthcoming book is about coercion and exploitation and a variety of ethical issues including the increasing number of pharmaceutical companies conducting "off-shore clinical trials" in less developed countries. He's also exploring the idea of people's moral obligation to actions like voting, reporting a crime, or giving blood.

"Alan is working on some incredibly important issues right now," says Emanuel, who tried to sign Wertheimer to a five-year contract two years ago. "It would be a tragedy if he slowed down now."