THE LACK OF GLOBAL MEDICINE CONTROL IN SOCIETY

Throughout this course we have discussed the ways in which we can provide medical resources in order to improve the health of individuals in developing countries. A substantial amount of the class readings focused on the lack of medical treatments and limited access to essential resources that are desperately needed by suffering patients. However, how much knowledge and control do people trying to help possess over the quality and distribution of medicines? I believe that WHO needs to establish a more active role and evaluate the drug regulations/policies that are in society today. It is not right to take advantage of people who do not possess access to resources and technologies that inform people of medical remedies.

In a recent study, out of thirty-five samples of co-trim oxazole purchased in Ghana, Nigeria, and Britain, only sixty percent contained the requisite amount of the active ingredients needed! Another study estimated that over 120,000 children under the age of five years-old died because of ineffective malaria medicines (NY Times). The fraudulent crime of marketing these substandard medicines has increased over the past decade. Manufacturers have discovered ways to sell medicines and save money by reducing the amount of active ingredients. By committing this crime, it can accelerate the development of resistant germs, and thus, infect new people (NY Times). What steps need to be taken in order to address these issues and form regulation policies?

If you can recall from the beginning of the semester, we discussed how tobacco companies have inserted themselves in the market to poorer nations. People in the US recognized the direct correlation between tobacco users and cancers, so this once “attractive” product now possessed a “dirty and unhealthy” stigma. Therefore, the trend in the US started to decline, manufacturers had to focus on a new audience to target in order to gain a profit. Today, 80% of smokers live in poorer countries (Mason, Corporate Power Lecture). According to Allan Brandt, “This is not really consent in the meaning of consent, and that tobacco companies purposely engineer consent by marketing,” Poorer people are suffering due to the lack of knowledge and falsely advertised products (Brandt). This demonstrates how powerful marketing is in any industry. It appears that manufacturers in pharmaceutical companies are attempting to replicate similar concepts that tobacco companies successfully implemented years ago by selling “fake” drugs to people who are less knowledgeable and desperate to acquire adequate medications. Ultimately, this can cause more harm, and it also depletes poor people of the little money they have.

This proposes an issue to implement pharmaceutical infrastructures globally when we lack control over the quality of the supplements on the shelves. In Improvising Medicine, Dr. P expresses the urgent need for access to medicines for his patients. It is true that individuals in poorer countries are not provided with essential medicines, and if they are, they are listed at an unaffordable price. Not only do they not have medicines that US citizens acquire, but they barely have basic medical technologies, infrastructures, supplies-bandages, syringes, glucose sticks, and antiseptics (Livingston). Thereafter, it appeared that Halfdan Mahler had the same ideology of ensuring essential medicines were provided and affordable price to people in underprivileged nations. However, distinguishing what is an “essential” drug provoked huge debates, and people argued that the WHO was exceeding its role (Greene). Is there some way combine these ideologies that will provide fairness and equality to all people? Do we really want to implement pharmaceutical infrastructures that contain overpriced and falsely advertised drugs to poor and sickly patients? After reading “Stemming the Tide of Fake Medicines,” I am a little more skeptical about how people in developed countries should approach this issue. We could potentially making the situation worse by funding for infrastructures that contain harmful drugs.

This is not only a problem in poor nations, but this is also found in wealthier countries such as the US. The FDA is constantly recalling drugs in our local pharmacies (Prescription Drug Ads). Overall, I think this exposes the flaws that are currently found in pharmacies, and I believe that we need to address this problem before endangering the lives in other countries as well. At least we have access to knowledge about supplements; people in developing countries take what they can receive especially when it is listed at an affordable price. If the medicines are overpriced, this causes even more of a problem because now people are purchasing inadequate medicines at a price they cannot afford. They could use this money for other necessities such as food and water, which arguably could have cause the need for medicine in the first place due to the lack of sanitation.

Discussion Questions:

 

  • Harsh Chandra’s post (October 2nd, 2015) discusses how overpriced drugs are being offered to people in developing countries. It is heart-breaking to see that developed countries are scamming these poor people by selling drugs that do not contain the full active ingredients, and on top of that, they are selling these fake medicines at a price is equal to a person’s monthly salary. How do you think we (or the WHO) should address this issue? Is there a way we can regulate the drugs that offered to developing nations? Is it our responsibility?
  • Health as a human right is still not present in the US today. We have access to an abundant amount of drugs, but they are costly. Prices in the US can be up to ten times higher than other developed countries (Syrmopoulos). This is due to the US manufacturer’s freedom to set their own prices. That being said, how are we supposed to instill this ideology of “health for all” that Halfdan Mahler once advocated for? It seems implausible to implement this idea considering the US has yet to even accomplish this. Should we take a different approach to improve global health rather than the implementation of drugs?

Sources:

Outside Sources:

“Stemming the Tide of Fake Medicines.” The New York Times. Ed. Editorial Board. The New York Times, 17 May 2015. Web. 27 Oct. 2015.

“35 FDA-Approved Prescription Drugs Later Pulled from the Market – Prescription Drug Ads – ProCon.org.” ProConorg Headlines. N.p., n.d. Web. 28 Oct. 2015.

Syrmopoulos, Jay. “Chart Comparing Global Drug Prices Exposes How US Govt Creates Mega Profits for Big Pharma.” The Free Thought Project. N.p., 23 Sept. 2015. Web. 30 Oct. 2015.

 

In-Class Readings:

Greene, Jeremy A. “Making Medicines Essential: The Emergent Centrality of Pharmaceuticals in Global Health.” BioSocieties 6.1 (2011): 10-33. Web.

Livingston, Julie. Improvising Medicine: An African Oncology Ward in an Emerging Cancer Epidemic. Durham: Duke UP, 2012. Print.

Mason, Katherine. “Corporate Power.” BioMed Center, Providence. 21 Sept. 2015. Lecture.

Brandt, Allan M. The Cigarette Century: The Rise, Fall, and Deadly Persistence of the Product That Defined America. N.p.: n.p., n.d. Print.

37 thoughts on “THE LACK OF GLOBAL MEDICINE CONTROL IN SOCIETY”

  1. Hi Samantha,

    I loved your blog post and found it really interesting as well as very helpful to understand the lack of global medicine regulation that is happening in developing countries. The examples you used were very alarming and really put the spotlight on the inefficiency of some medicines and the fraud of some pharmaceutical companies, which were topics I had not heard of previously.

    Regarding you first question, I think that the issue of inadequate medicines and “fake” expensive medicines are big concerns that we need to address. I do not think that this problem can be solved if only one country increases regulation. In my opinion, a collaboration between both the WHO or the FDA and the government of each country is required to address this issue. On the US side of things, I think that regulations should be stricter for controlling the effectiveness and price of drugs that are sent abroad and that the government of the each country that receives the drugs should increase regulations to check the effectiveness of the drugs and make sure the doses of active ingredients are respected.

    Concerning health as a human right, you brought up a very interesting point that the US has still not achieved this and yet we are trying to implement this to developing countries. I agree that as long as the US has not achieved this, it will be very difficult to bring this ideology in other countries. As you said, there is still a huge health inequality gap with the rising prices of drugs that people can no longer afford. I think that addressing this issue would bring us closer to the goal of health access to everyone and it can be achieved by an increase in regulation from government organizations to keep the prices affordable by setting a maximum price companies can ask for or by stopping the idea of monopoly and patents rights.

    1. Hi Claire!

      Thank you so much for your comments!

      Referring to my first question, I completely agree with you. I think the US should establish stricter regulation policies. In section on Friday (11-6), we discussed accepting a deal with an unknown pharmaceutical company that would last for three years. Did you think that they should have accepted the deal? If so, why? How about now after reading this article on “fake” medicines? What do you think the pharmaceuticals main objective of this deal is? Should someone intervene?

      For the second question, do you think health should be considered a human right? Recently we read an article that explained how Brazil was one of the first developed countries to provide free distributions of ARVs to the entire population (Mason, 11-4-15, Pharmaceutical Fixes). This resulted in many lawsuits because people demanded access to more rare and expensive medicines/treatments. The ‘right to health’ morphed into the idea of ‘right to pharmaceuticals.’ Now Brazil is facing up to 13 times higher prices than the world index because pharmaceutical companies are taking advantage of this. If pharmaceutical companies agree to lower their prices, should we expect some sort of trade off? Do you think this will result in more “fake” drugs? How can we ensure that we are receiving adequate drugs? Arguably, pharmaceutical companies are trying to maximize their profit like most other companies. However, should there be stricter laws or more standardized ways to provide affordable AND adequate drugs to populations?

      What are your thoughts?

      1. Hi Samantha,

        Concerning your first question, my group had decided to accept the deal with the pharmaceutical company because the investors in the case study were waiting for results in a very short time period. However, we did set up conditions to accept the deal such as the drug needed have gone through trial already and had to respect the amounts needed for the drug to work. We did take into consideration how, like we said in section, antidepressants are addicting and once you start them, it is very hard to stop. Moreover, the fact that this company was giving out free antidepressants could be somewhat “sketchy” and could lead us to think that these were “fake medicines” In order to counter this problem, we decided to accept this deal only if the governments from Haiti and the WHO would regulate the quality of the drugs that were sent to Port-au-Prince and that it would be highly mediatized. Often, the problem with fake medicine is that pharmaceuticals are sending the medicine far from where they are, in remote places, and therefore feel less accountable if a problem arises.
        Concerning your second question, I do think that health should be a human right. As we saw in class, the example of Brazil does show how setting health as a human right can have huge impacts on the price and quality of care in a country. However, I think that the problem with the price increase could be resolved if the government of the country were to regulate the prices of drugs by bargaining with the pharmaceutical companies. I do see how this could also potentially lead to an increase in fake drugs but I think that, once again, government regulation and high media exposure could reduce the risk of using fake medicine. I do think that there should be more government regulation on the prices of drugs because even today, in developed countries, people do not have access to necessary treatments due to their high prices. I think that everyone should have access to affordable and efficient drugs.

        1. Hi Claire!

          Thank you for your response!

          I agree with what your group decided on, and I think that your group brought up some really interesting concerns to discuss. In the film that we watch ed on Wednesday, villagers would assign medical assistants to make sure people were taking their drugs accordingly. We also talked about this in our last class last Monday 911-22-15). I think that this would be a good idea in order to make sure people do not hoard medicines, take the medicines properly, and do not sell them. The medical assistants do not get paid, however, they still can benefit from these programs such as Partners in Health. What are your thoughts?
          I also agree that the government should regulate the prices of drugs to stop pharmaceutical companies form taking advantage of countries. I also agree that everyone should have access to basic medicare. I think it is important that we establish what is “essential,” which can be difficult to do.

  2. Hi Sam,

    Your blog post was very interesting and informative, and the many statistics you mentioned truly highlight the concerns and inequalities that are prevalent in the global health system. It is rather alarming to observe the unethical fraud that many companies commit in order to make profit while endangering customers.

    To answer your first question, I think the governments of both the importing and exporting countries should increase regulation and control over drugs as a pharmaceutical fix. I do believe that we, as a developed nation, have a role to play in minimizing the harm that fraudulent companies impose on those of developing nations. I think this issue is a crucial aspect of global health that needs to be addressed by the WHO and the governments. With increased regulation and control over such drugs, those of developing nations will not be scammed into spending and becoming ill.

    I think your second question revolves around many of the issues we have discussed thus far in lectures and sections. It is a question that involves ethics and morals, as health should be granted to everyone. The stark inequalities of medicines have yet to decrease, and more and more people are suffering daily. That being said, I still believe it is important to instill ‘health for all.’ I believe that governments play a major role in the ability to create health as a human right, and with certain approaches, we can slowly but surely inch forward to a society of better equality and health for all.

    Such a process will be slow, so I think it is important to measure the effectiveness and improvements starting with one nation, and then slowly move to a global level. It is more practical to measure the effects on a smaller population scale, and then implement such a system to a wider population.

    1. Hi Julianne!

      Thank you for your thoughts!

      I totally agree with you and Claire that importing and exporting countries should both increase regulation and control over drugs. Why do you think this has yet to be questioned? Playing devil’s advocate—do you think it’s fair to the pharmaceutical companies to control what they can and cannot sell?

      How do you suppose we ensure ‘health for all?’ I don’t think there is a right or wrong answer. I’m just curious. Do you agree with people such as McKeown who tried to show that interventions (medications and vaccinations) do nothing at a population level (Mason, 10-5-15, Inequalities in Medicines)?

      Do you think there is a possibility of unintended consequences such as the ones we mentioned in class: ex. Brazil, which progressed from ‘right to health’ to ‘right to pharmaceuticals?’ Now Brazil faces large prices for medications by pharmaceutical companies. Is there a way we can stop pharma companies from taking advantage of individuals?

      1. Hi Sam,

        To answer your first question, I think the main reason that this issue has yet to be addressed is because of the profit-based incentive. The governments and companies involved are focused on the distribution of economics, and if they are making profit and having success, they will not question their system. That being said, I think it is crucial for those who do recognize this issue to bring it to the forefront of the governments and policymakers.

        To answer your second question, I do believe it is fair for governments to control what pharmaceutical companies can and cannot sell. These companies sell products that alter one’s health, and therefore it is crucial for these products to be regulated.

        I have a hard time figuring out the exact way to approach ensuring ‘health for all.’ Similar to your stance, I don’t think there is necessarily a right answer. There are many ways to go about this difficult topic, but I think the most important approach to be taken is through politics and governance. Essentially, policymakers and people employed by the government play a large factor in ensuring these rights.

        In response to your last question, I think there will be unintended consequence with any approach to global health issues. However, that should not make one hesitate to step in where needed. In such a case, I think it is important to weigh the pros and cons of potential interventions, with the cons being the unintended consequences.

        1. Hi Julianne,

          That definitely makes sense. It’s sad that everything seems to be based on money rather than the health of suffering people.

          I agree with your second comment as well. People deserve their right to the best quality of health especially if they’re paying for it. Do you think we should enforce punishments to fraudulent pharma companies?

          I think that maybe the US needs to improve our healthcare system. Instead of testing our theories on other nations, we should try changing what we’re doing to provide health for all.

          I also agree with your last comment. Sometimes I think the biggest mistake is not taking any risk at all–as long as the risk is thoroughly investigated and planned out.

          What do you think our next step should be to improve health in the US? What about for other countries?

          1. Hi Sam,

            Thanks for your response – you brought up some insightful comments that relate to this topic.

            In response to your first question, I think it is absolutely essential to enforce punishments to fraudulent pharmaceutical companies. As I mentioned earlier, these companies sell products that alter one’s health – it would be unethical to be a bystander if these companies are causing harm to one’s health.

            I think a response to your second question embodies one’s political stance. Depending on what one thinks of ObamaCare, there are many different approaches as to how to improve healthcare in the US. Leaving politics aside, I think in general, the best way to improve healthcare in the US is to figure out what should be valued – people or the economy. To improve health internationally, I think it is important for the US to set a successful example, and then lead other countries to do the same.

        2. Hi Julianne!

          Sorry that I replied to this one, it won’t let me reply to your last comment (11-12-15)

          Thank you again for your response!
          I agree that we need to punish pharma companies. Katherine Armstrong suggested fines, but also noted that fines might not be a harsh enough punish to stop pharma companies from repeating this crime. Silvia mentioned a very different approach. She suggested promoting generic medicines over brand names in order to create a “healthy” competition. Whichever seller “plays the most fair” would be able to sell their product. Therefore, this strategy would create an incentive to make adequate drugs to sell, otherwise they will not make a profit.

          What do you think?

          I also agree with your second comment. In section on Wednesday (11-11-15), our guest speaker, Lindsey, mentioned that we often focus too much on quantitative data rather than on the population’s well-being. We could possibly find ways to see what people are most interested in and most desperate for, and then implement infrastructures, medicines, and/or treatments that would be of their desire. Maybe this will create more participation from people, which Lindsey said was often a problem when performing their clinical trials. This is more of a horizontal approach, which is typically difficult, but I think that this is the best step going forward.

          Any thoughts?

          1. Hi Sam,

            Thanks for your reply. I think Dr. Lindsey Reynold’s approach has the capability to be very effective, as I believe focusing on the population’s general well-being will produce greater results instead of relying solely on quantitative data through testing. Potentially, from focusing on the population’s well-being, there could be advances that can lead to more effective testing with quantitative data. I think that quantitative and qualitative data are both essential when creating solutions to issues amongst a population.

            To answer your first question, I think Silvia brings up an interesting approach to this issue. However, I am not quite sure how one could measure who is playing “the most fair.” While I think that this is a good idea, I don’t think it is very realistic. Ideally, we want pharma companies to have an incentive to sell adequate drugs, but I am not sure if this is the right approach. I agree with Katherine Armstrong in that fines are not a harsh enough punishment for pharma companies committing these crimes. Essentially, these companies are altering people’s health, and I do not think that fines are a just punishment for such actions.

          2. Hi Julianne!

            Thank you for your response!

            I agree. I think quantitative data can be effective if we use it in the right way. I think we should use quantitative data as our guidelines, but channel our focus more on qualitative data as it reflects the well-being of the people in the program. NGOs could send out questionnaires where people respond 1 to 5, one being ‘I disagree,’ and five being ‘I agree:’
            1) I found this program to be effective
            2) I have seen improvements in my health and/or family member’s health
            3) I have created a relationship/bond with leaders in the NGO
            4) I would like to continue working with this NGO in the future
            5) What would I like to see change or think this NGO needs improvement:
            Yeah, it would be hard to measure ‘fairness.’ I think it is an important issue to discuss because like you said, pharma companies do need to sell adequate drugs to all customers. I think fines will not be effective either (like I said earlier), but I’m really stuck because I don’t know how to solve this problem of justice. You would think people would just want to help and not solely focus on their personal gains

  3. I think you brought up some very important points about the pharmaceutical companies, drug-dumping, and regulation. In regards to your first question, I think that we definitely should take responsibility to regulate medicines being distributed abroad. For starters, there should be a standardized quality of medicine being exported. If something would not be accepted in the US, we should not profit off of the fact that other countries have limited access to quality medicine. I think the WHO can approach this by creating quality standards, regulating prices, and reconsidering patent regulations.

    In response to your second question, I think that health for all is still a worthwhile goal, but unrealistic at this time. It is important to consider what will do the most good for the most people for the most time, and while medicine is a quick solution for many diseases, it does not bring about lasting change. It is still important for medicine to be present because it is unacceptable that so many people die from treatable diseases. However, going forward I think it is important to emphasize the structural problems that allow for this to remain a truth in our world, and shift the focus from essential medicine to structural changes.

    1. Hi Leah!

      I think your ideas are really good and make a lot of sense. However, if the WHO creates quality standards, will this make prices for drugs too expensive for poorer nations to acquire? What do you suggest we do to ensure the ‘right’ price for these drugs? Why do you think the WHO has not already mandated this?
      I agree with your second comment regarding the unrealistic idea of ‘health for all’ that Halfdan Mahler once envisioned by 2000. I believe that we discussed in section whether the Alma Ata was too idealistic. In our section, we pointed out that although this document was very idealistic in promoting global health. It did not provide steps, evaluation, or procedure to implement these goals. Do you think we are too idealistic? Is it necessary to be; and to what extent do you think that we should be idealistic vs. realistic? By what structural changes are you referring to or do you suggest that we focus on?

      I really like your thoughts. It seems so simple, yet we are still unable to create equality in global health. It’s frustrating!

  4. Hi Samantha,

    Thank you so much for your post, as I was reading it I was disgusted to hear about the fake medicines being shipped to developing countries. Not only is this an outrageous and horrific action by the pharmaceutical companies, but also can contribute to resistant strains of infectious diseases and make it even more challenging to combat health issues in developing countries. In response to your first question, I think this is definitely something that needs to be addressed. First of all, for the WHO to create an essential medicines list, encouraging pharmaceutical companies to boost profits by generating drugs that will get on the list, but not regulating these drugs, is grave misstep. Furthermore, I think by creating a worldwide essential medicines list instead of regional lists further compounds this problem. Not all countries and regions experience the same health challenges, and generating a list based on the assumption that they do can create unequal access. Additionally, if US based NGO’s are going to supply developing countries with US pharmaceuticals, it is the FDA’s responsibility to regulate. While this may be an inefficient step, and one the FDA certainly would not like, I think there should be random efficacy checks on drugs shipped to developing countries in order to keep pharmaceutical companies honest.

    I liked your second point about how many US based aid organizations support health as a human right, yet the US has not implemented this idea itself. However, while the US may not have health for all, the US can definitely relate to the high prices of drugs limiting access, like you mentioned. Additionally, I think there is a difference between advocating for health for all and encouraging affordable access to drugs in developing countries. Again working with countries and communities is an essential part of any global health work. If communities or countries believe in a right to health, I think the WHO has an obligation to help maintain this right. However, if we don’t set a worldwide precedent for health as a human right, what do we do when developing countries have people suffering, but still do not acknowledge this right?

    1. Hi Sarah!

      Thank you for your comments!
      I had the same reaction after reading this article. Honestly, I don’t know how people can live with themselves and not feel ashamed. It’s so sad, and it makes me sick. I feel even worse because now I know about it, and yet I can’t do anything about it.
      By creating a worldwide list of essential medicines, how do you think pharmaceutical companies will react? How can we establish ‘essential vs. nonessential’ drugs? How can we ensure an affordable price for these drugs?
      I think it is a good idea for the FDA to have random drug tests as well. I understand that this process would be time-consuming, and I’m shocked that this has not already happened. It also leads me to question how effective our drugs are.
      In response to your second comment, if countries do not value as a human right, do you think developed countries need to step in? Natalie Asalgado describes the use of “magic bullets” in society today. She states that, “Magic bullets have the benefit of being simpler and more cost-effective than longer-term goals, but also distal to the social determinants of health.” Do you think that magic bullets would be a more effective approach to provide/offer health care? Just curious.

      1. Hey Sam,
        For the last part of the semester I have been struggling with the question of how do we actually enforce pharmaceuticals to lower their drug price. I think that pharma has little to no incentive to actually lower their prices unless a regulator gets involve. Appealing to the good nature of the companies will only work so far, as their main focus is to make a profit and pay their workers. For the US, I think the government, including the FDA, needs to step up on regulation of drug prices, however this seems unlikely as Congress has proven that they support many companies in their pursuit of profit, including pharmaceutical companies. We need an international regulator, but I don’t know who that would be. Logically, I would hope the WHO could step up, but since we have heard time and time again that the organization has “no teeth”, I hesitate to say if this could actually be implemented.

        I don’t think that magic bullets would be a more affect approach to health care because it focuses primarily on biological fixes. As we have learned, social factors can influence biology as explained in the biosocial approach. In many of these countries, structural violence and inequality have a big influence on health. By applying magic bullets, you treat the disease, but you do not address the cause. Overtime this means more, expensive, interventions to treat a given disease again.

  5. Hi Samantha,

    I loved your blog post and the fact that you tied our more recent discussions about essential medicines with topics we discussed earlier in the year such as the power of corporations, the tobacco industry, and the disparity of knowledge in different countries. Essential medicines hold some of the same problems as the tobacco industry, and I was shocked to read from your post that pharmaceutical companies will reduce the amount of active ingredients while hiking up drug prices. I hadn’t heard of this before, and I can’t imagine how many others are paying for less effective medicine than they deserve. I found myself asking, “Where is the regulation for this?”, and many others are probably asking the same thing.

    I want to believe that there is a way to regulate companies and ensure fair distribution of medicine, but corruption can be hard to pinpoint, and thus hard to stop. The more exposure there is about issues like this, the more likely they are to be fixed, because a strong public opinion can sometimes cause profound changes. This said, those who are in a position of power, or who work in regulatory organizations such as the WHO also hold a high level of responsibility because I feel like that is what the organization is set up for. As for the United States, I think we still have to work on ensuring health as a human right on the home front in order to encourage this idea across the world.

    1. Hi Thu!

      Thank you for your insights!

      Do you think we should ensure health as a human right in the US? I’ve asked a couple of the other students in class who have commented on my post so far what they this of health as a human right. Brazil is among one of the very few countries to provide free ARV distribution to the public. However, this escalated into a higher demand of other treatments/medications by citizens. Thus, pharmaceutical companies charge up to 13 times higher prices for drugs. Do you think this will cause problems? Should we set a cap on prices that pharmaceutical companies charge? Or is that unfair to pharmaceutical companies that are trying to maximize their profits just like every other business?

  6. Hi Samantha! Thanks for all of your insightful ideas. You brought up some really great points. In particular, I like that you linked the pharmaceutical industry’s tendency to give lower-quality drugs to poor populations back to the big tobacco industries and their engineered consent. In a poor country in which the ultimatum is to buy a drug with less active ingredients or take nothing at all and suffer the consequences, it seems that people don’t really have a choice in the matter. Although the following is a fictional scenario, such a conundrum reminds me of a character on the show Sense8 who lives Kenya and engages in deals with a violent druglord in order to provide non-watered down AIDS medication to his mother. Like many others, poverty drives him to risk his body in a way that cannot really be called true consent.

    But like you suggest, attempting to regulate pharmaceuticals in developing countries when we don’t even have a stable system ourselves is questionable. It seems that the best option would be to have local governments in charge of such an operation. Still, unstable governments are rampant in the settings where drugs are being watered down or in some cases, replaced with placebos. If we look to the WHO, we find an organization who’s all grin but no teeth. Perhaps mobilizing the WHO with bodies capable of entering into the field to enforce drug safety is the first step in addressing the issue. Of course, this “solution” has problems of its own that need to be explored more at depth.

    1. Hi Lillian!

      Thank you for your inputs! I really like the reference you gave, and how you connected it to my post.

      How do you suppose governments and organizations such as the who enforce drug safety? Do you think there should be a harsher punishment if they find a company guilty of such fraud? What should be a justified penalty for their actions?

  7. Samantha,
    I really like your post, and I especially like how you draw parallels between the pharmaceutical industry and the tobacco industry. This is especially scary in the context of “drug-dumping” (Greene, 16)—the process in which pharmaceutical companies sell drugs that don’t meet high regulatory standards in some countries to countries with weaker regulations. That’s very reminiscent of tobacco products being sold in countries with weaker regulations and less dissemination of health knowledge.
    I’ve been thinking about your first question, asking how to address the issue of pharmaceutical companies selling over-priced, fake drugs to developing countries. My understanding is that the Essential Medicines list, despite all its shortcomings, could be a good first step. Wasn’t its original purpose to increase the availability of these “essential” drugs throughout the world? That would help with distribution and price control (at least for the drugs included on the list), I would think. You phrase your question as “we”—“can we regulate the drugs?” I think that it might not be the US’ responsibility to regulate drugs to other countries (I’m not a political scientist, but I wonder if the US would have the political force to do so?), but it is the WHO’s responsibility. Especially since the WHO was responsible for creating this list in the first place. As you’ve said, if fake drugs are being distributed, it is an inexcusable disaster—people will remain ill, and germs may develop resistance. To me, this is intolerable—I think the WHO should work to establish more strict, international regulations to prevent this from continuing.

    1. Hi Lindsay!

      Thank you for your comments. Your reference to “drug dumping” was a perfect term to describe what is happening currently happening in poorer nations. It’s so hard to be knowledgeable of this, and yet have no control to stop it.

      In response to the first question:
      I think creating an ‘Essential drugs’ list could be beneficial. However, I’m still skeptical about how valid these drugs are. Do you think the WHO could make an approved list of valid and essential drugs list as well?

      How do you think the WHO should establish stricter international regulations? Should there be a penalty? Fines, discontinued use, stigma attachment? I personally don’t know. I’m just throwing out some ideas. I would like to hear what you think!

  8. Samantha,
    Thank you for your insightful post on the quality of drugs in the world. I never knew about this issue of inaccurate amounts of active ingredients in prescription drugs, only in supplements.

    To answer your first questions, I think that if the WHO is saying that certain drugs are “essential” then they should be monitored and ensured that they are properly manufactured in the future. One way this could work is through random sampling and testing of a package of drugs. The WHO could either anonymously order drugs or have drugs ordered to certain labs around the world, and then test the drugs effectiveness every year or 6 months (but not on a specific schedule). If a drug does not pass the test of being properly manufactured with the correct amount of active ingredient, then they pharmaceutical company would be penialized, possibly through having countries switch to generic or being fined. The problem is incentivizing pharmaceutical companies is difficult because getting fined is often no big deal to them and they may be the only company that makes a certain drug. I think it’s necessary to ensure that people who are spending precious money on a drug are getting what they need.

    I think that since the US doesn’t have the true motto of “health for all” it is difficult for them to force other countries to to observe the same right. However, the WHO is made up of a variety of countries, many of which do believe in “health for all,” so I do not think that this ideology could be changed just because the US doesn’t outwardly express this. In fact, I think the WHO needs to help the US achieve a standard of care too.

    1. Hi Katherine!

      Thank you for your comments! I was also appalled by this article. It appears that a lot of people so far have been unaware of this issue, and I think it should be addressed.

      I also really liked your thorough explanation of how the WHO should, and could, better monitor the drug companies. I also agree that if found guilty, they should be fined or at least penalized to some extent in order to reduce drug fraud. Doesn’t this issue kind of make you concerned that all the help “we” (people in developing countries) have tried has possibly made people in poorer nations poorer and sicker? This whole idea sickens me, and I wish I could do more to help. I agree, I don’t think a fine is harsh enough. Although, I also do not have a solution either.

      To what extent do you think ‘health for all’ should mean? Do you think there should be a list of essential medicines, or literally health for all–no matter what? Will this become too costly? Will people take advantage of the system? An even better question, will pharmaceutical companies take advantage of this system and charge higher prices because they know health is ensured for all people?

  9. Hi Samantha,
    I really enjoyed your post about the corruption and deception of the pharmaceutical companies. I appreciated how you tied in the comparison of the tobacco industry to the pharmaceutical industry (which I agree are very much alike in many ways).
    In response to your first question, I think that organizations like the WHO find it very difficult to regulate the pharmaceutical companies because of how much power they have. The fact that they got away with selling unsafe drugs, attests to the amount of power that this industry has. Thus, I think that the way to approach this problem is through decreasing their economic gains by purchasing more generic brands, and giving the pharmaceutical companies a reason to work more morally. If doctors partner with generic brands instead of with pharmaceutical companies, then the money (and thus power) that the pharmaceutical companies have will slowly decrease. By decreasing the company’s power, regulation will thus become easier.
    In response to your second question, I think that it is difficult to asses where exactly is the best target of global health. I think that addressing immediate health problems (through medicine) is extremely important , but at the same time this brings up the question of valuing bare life over a life well lived (zoe vs bios). By implementing a set of essential drugs, the question of survival is being addressed, but the socio-political issues (that many caused the disease in the first place) have not been addressed. Therefore, I think that global health should not just solely focus on medications but also on improving sanitation and nutrition, in a way that is locally sustainable. That way both survival and well-being will be addressed.

    1. Hi Silvia,

      Thank you for your thoughts! I was deliberately trying to relate this post to the tobacco topic because they are both negative issues that need are similar and need to be addressed.

      http://www.medicinenet.com/script/main/art.asp?articlekey=46204 was a short little article stating how generic medicines are often looked down upon even though the FDA requires that generic medicines are just as safe and effective as brand names. That being said, I agree that purchasing generic medicines could help incentive pharmaceutical companies to make more ethical decisions. Katherine Armstrong (comment before yours), suggested fines, but also thought that a fine would not effect companies enough to cause them to stop selling ‘fake’ drugs. I think you bring up an interesting alternative that would create a ‘healthier’ competition between generic and brand name drugs–whichever company is more fair, effective, and applicable to populations is the product that will survive.
      I also like your idea to improve sanitation and nutrition. I believe that the main causes of these diseases are due to the lack of nutrition and sanitation that poorer nations live in. Should the WHO and other organizations focus their efforts and money on these factors rather than deciding on punishments for pharmaceutical companies?

  10. Thank you for your post Samantha,

    I think this problem would best be addressed by new legislation from the WHO requiring drugs to contain the active ingredients that they are supposed to. These new regulations should be strictly enforced either by the country where these drugs are being produced, relying on accurate quality control measures. To ensure that these drugs are available to everyone, following Mahler’s idea of “Health for All”, Drug companies should not be able to set their own prices. By letting countries set the price that they are willing to pay for medications, the hope would be that these drugs could be made available to everyone. Of course there are many more approaches to improving health than just medicating a nation, however I believe the best result in improving health will come from implementing these changes while also offering medicines at affordable rates combining the benefits of both.

    1. Hi Steven!

      Thank you for your comment!

      I agree that the WHO should mandate that pharmaceutical companies have all active ingredients that are needed. However, I think these companies are taking advantage of their power because no one does regular checks on their drugs. I think by having random drugs test, this would help solve this problem.
      I wish pharmaceutical companies would just make ethical decisions and try to improve the health of others who need it most. It’s sad that they charge overly high prices just to help their profits, while other people are starving and dying. Claire suggested that the WHO regulates the prices the pharma companies sell their drugs at. I think this is a really good idea. What do you think?

  11. I’ve been looking at a lot of posts from this section as well as the Corporate Power section because I thought that section closely related to the article I looked at about the unethical procedures of pharmaceutical companies.

    This class has made me more cynical of how the world is in general and how selfish people are. I liked the comments and suggestions people left on my post about possible randomized tests, or fining pharmaceutical companies, or somehow punishing their fraudulent crimes. I’m still upset that we have to do this in the first place. Many people try to help developing countries by funding organizations, and then we have pharmaceutical companies destroying the hopes and progress that we have made. I think we all just need to be less selfish and remember the term of liberation cosmopolitanism defined by Thomas Pogge who demonstrates that if we had no prior knowledge of where we might end up in the world before we are born, how would we set up the world? He shows that most people advocate for an egalitarian society because they do not want to risk the chance of being like “them,” or people suffering in third world countries.

    Why can’t we just go over to third world countries and help them build infrastructures and provide medicines free of charge until everyone is better? Why can’t we provide food, water, and shelter to these people? I understand that it is costly to do this, but why can’t the world just agree to send people to do these things free of charge? We look at this situation as “them” vs. “us,” but in reality, what happens to “them” really does affect us.

    1. Hi Samantha,

      I too find myself more cynical after taking this class. Upon reading your questions at the end of this post, I keep thinking of unintended consequences of any actions. When I first read Merton’s article on unintended consequences I was extremely frustrated by the inaction that can result from being too careful. I still find myself wondering, isn’t it better to act and make a mistake and address that mistake, than to not act at all? One thing I have realized from this course is that even if we provide food, medicine, and shelter to countries free of charge, there is no permanency. It takes development of sustainable training programs, and care programs. And even then, if the country doesn’t find the necessity and priority in maintaining these programs, aid workers will be back to provide care in a few decades. These international and societal level changes that are necessary worry me, because I’m not sure there will ever be a true incentive to accomplish such immense goals.

      1. Hi Sarah!

        Thank you for your comments! I’m glad I’m not the only one. I just wish there was something more that we could do to motivate people to accomplish these goals. I remember in class we discussed the roles that images and statistics have in helping to motivate people to help. Although, studies were shown that people tend to not be as effected by these alarming statistics.
        I found an article (http://www.uniteforsight.org/global-health-university/photography-ethics) that explains how imagery can sometimes lead to false illusions of the poor, and also lead to some ethical questions. I can vividly remember the picture that was shown a couple times in lecture of the little boy (probably 3 years old) who was struggling to crawl (perhaps to water or his village). Although, the point of the picture was to show this boy was struggling, people may question the photographer why he did not help the boy and criticize him for focusing too much on taking pictures and not helping the boy.
        I think that images and data are not as effective as they used to be, and this could be the reason why people do not help as much as we would like.
        From a personal perspective, I love to help. I volunteer a lot through church, hockey, and other opportunities. However, I find it more rewarding to see my work actually helping and being implemented. This could also be a reason to why people do not help as much.
        It is important that we find ways that motivate people to help and show that this is a major issue in society.
        How do you think we should do that?

        1. Hi Samantha,

          For the most part, I think people understand that global health is a major issue in our society. People vaguely understand that others are starving and suffering, but perhaps do not know the severity of the problem. I think it is difficult to get people to volunteer and contribute because people don’t understand the impact they can make. They assume that the problems are so advanced that it takes billionaires to solve them. And while the problems are serious, anyone can help. Volunteerism is something that many NGOs struggle with, and with images and data having less of an impact, I don’t know how to energize a new batch of volunteers.

  12. Hey Samantha,

    Thank you for your post! You made some really good points and the figures you used really did a great of of highlighting a lot of the problems within this topic. I also was unaware that the amount of active ingredients in dugs was being altered.
    I definitely that a lot of the stuff we have learned about and discussed in this class has the tendency to give you a more cynical outlook. I think this is especially relevant in this topic and the corporate power topic because the health and well-being of many people, especially people who we deem to be “other” become contrasted with the opportunity for making money of few powerful people .

    In regards to your first question I think that there definitely need to be something done by the WHO, and although I am aware that there are limits in the actual power of the WHO, I think there need to be legislation in place, and consequences set up for pharmaceutical companies that don’t meet certain ethical guidelines such as having the correct amount of active ingredients. Beyond that I think that incentives need to be put in place for companies to behave in ways that align with morality and ethics of global health.

    1. Hi Yilena!

      Thank you for your comments! How do you think we can motivate pharmaceutical companies to behave ethically? I also agree that the WHO needs to address these issues, however, I wonder why they have not already. Could there be a reason for them not to do anything?

  13. Hi Sam,

    The website would not let me reply to your comment on 11-20-15, so I hope you’re able to find this response!

    In your last comment, you mentioned the idea of NGOs sending out questionnaires where consumers can respond to programs on a 1-5 scale. While I believe that this is a neat idea, I am not sure how effective it would be. I think a potential problem with this is that people may not be inclined to fill out questionnaires, and send them back to the companies. It may be tedious and an extra thing to add to their already-busy schedules. I agree with you in that the main focus of these pharma companies should be on the health and improvements of their consumers, however, that is unfortunately not the case.

    1. Hi Julianne!

      Thank you for responding!

      I agree that this may be tedious, but I think that this will help NGOs gather helpful information and feedback to how they are responding to the people’s needs. This does not mean that they have to look at all questionnaires, but even a couple. Or when volunteers help people in homes, they could have a mini-interview with the patient to ask how their visit was or leave a questionnaire with them and ask that they fill it out and return it during their next visit.

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