The field of global health is constantly evolving. From its murky origins in colonial medicine, to its shift from vertical to horizontal care, to today’s technological age, global health has been shaped by a variety of societal forces. Today, we observe the phenomenon of pharmaceuticalization (Biehl et. al). With scientific and technological innovations, diseases like tuberculosis, malaria and AIDS, that were once thought to be fatal are now treatable. It is unjust to discriminate who deserves biomedical cures for life-threatening diseases based on race or socio-economic status. Doing so would deepen inequities and promote forms of structural violence (Farmer 265). In response to this problem, in 1975, WHO Director-General Halfan Mahler highlighted the need for a list of basic, essential medicines that every individual deserves access to. The WHO published this list of “essential medicines” two years after his speech. This list was assimilated after consulting ministry officials, doctors and health care providers across over twenty-five countries (Greene 17).
While the document was no doubt well intentioned, the subjectivity of the word “essential” itself makes me question its effectiveness. The criteria used to dictate which medicines made the list and which did not, were not necessarily comprehensive. The idea of “local biologies,” itself shows that there is a great deal of regional disparity among the symptoms of various afflictions; certain diseases have more potent effects than others due to cultural and social differences among nations (Lock 1). How can we create a blanket list of only 186 worldwide “essential medicines,” when each region and its government have specific health issues and unique barriers to access drugs?
Furthermore, our list of “essential medicines,” may in fact perpetuate inequities rather than eliminate them. For example, it favors prevalent conditions over rare diseases (Greene 18). In the summer of 2013, I interned with the Rare Genomics Institute, an organization focusing on developing treatments and bringing awareness to those suffering from rare genetic diseases. After interviewing over thirty individuals with rare diseases, a common theme emerged. There was a lack of research and development for cures due to the low profitability of rare disease ventures. Rare disease drugs, also known as “orphan drugs,” were not seen as profitable by large biotech companies (Jessop). Or, if the drugs were available, they were placed at exorbitant prices. Is it just, to tell a woman I interviewed with Gaucher disease, that she deserves to pay $310 250 for one therapy treatment? Neglected by the health care system, many individuals suffering with rare diseases succumb to despair and hopelessness. Is it fair to favor the majority in our definition of “essential”? The blanket statement of the word “essential,” gives biotechnology companies and governments an excuse to not care for those in the minority. In addition, its inflexible structure obstructs new medicines from being added, preventing individuals from benefiting from the dynamic innovation occurring in the global market.
What truly is concerning, is that pharmacologists developed the first list of essential medicines (Greene 24). In today’s market, pharmaceutical companies have the power in deciding what these “essential drugs” are and how much they should cost. A recent controversy regarding drug pricing has emerged from an agreement known as the Trans-Pacific Partnership (TPP). A Wikileaks document shows one of the final drafts of its chapter on intellectual property, which entails policies that will limit the competition of generic drugs. Through allowing patent term extensions and market exclusivity for drugs, this agreement will result in higher drug prices (Gleeson 1). Especially in developing countries, with weakened economies, this agreement will prevent access to affordable medicines. Medicins Sans Frontiers and other international organizations have protested the institution of this plan due to its destructive effects on the poor (Medicins Sans Frontiers). In Julie Livingston’s Improvising Medicine, we can see the devastating effects resulting from a scarcity of affordable medicines. In PMH, “some people shared stories of a profound physical agony and deaths born of the near total lack of medicines, sutures and bandages” (Livingston 177). It is not ethical to have a system where corporations and market- driven governments profit from causing misery and death. Yet, Greene notes that pharmaceutical companies brand themselves as “global health,” companies, falsely portraying themselves as supporters of the WHO’s initiatives.
And so as we shift towards emphasizing PHC, we must recognize that in some ways, the WHO’s list of essential medicines is enabling the oppression of the poor and supporting pharmaceutical companies in their profit- driven initiatives. While the WHO’s list of essential medicines was an important start to promoting health equity, I believe that we must look towards new approaches in the 21st century.
- The definition of “essential,” has caused great debate in the global community. Currently, the WHO has defined its list of essential medicines based on popularity, previous establishment, efficacy and cost. How do you think the word “essential” should be defined? Do you think it is necessary to have a list of essential medicines? Should the WHO redefine or modify its list?
- In the case of pharmaceuticals, do you think it is possible to balance profit- driven incentives with a desire to improve the common good? In other words, can we still create incentives to innovate while ensuring the affordability of essential drugs?
In Class sources
Biehl, Joa. When People Come First Critical Studies in Global Health. Princeton: Princeton UP, 2013. Print.
Farmer, A. Kleinman, J. Kim and M. Basilico, eds. 2013. Reimagining Global Health: An Introduction. Berkeley: University of California Press.
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.
Lock, Margaret. “Menopause, local biologies, and cultures of aging.” American Journal of Human Biology 13, no. 4. 2001.
Out of Class Sources
Gleeson, Debrorah. “Comments on the Completed Trans Pacific Partnership (TPP) Intellectual Property Chapter.” N.p., 10 Oct. 2015. Web. 01 Nov. 2015.
Jessop, Nathan. “The Dilemna with Orphan Drugs.” PharmaTech. N.p., 1 Aug. 2013. Web. 2 Nov. 2015.
“Statement by MSF on the Conclusion of TPP Negotiations in Atlanta.” MSF USA. N.p., 05 Oct. 2015. Web. 01 Nov. 2015.
26 thoughts on “Are Essential Medicines Really Essential?”
I really enjoyed your blog post and reading about your thoughts on the effectiveness of the list of essential medicines. Your perspective on the inequities between disease treatments caused by this list, where rare disease treatments are lacking, was a new angle I had not thought of before.
Regarding your first question, I think that the word “essential” should be treated with caution. As was the problem with the list of essential medicines, people interpreted this as the medicines that were not on this list were non-essential. Therefore, I think that it would have a stronger meaning if it were to define the baseline of efficacy and affordable medicine that everyone should have access to. Although I do think that the list of essential medicines is a good and important idea to have, I also think that it should not be emphasized as the only way to promote health care. I think that promoting better living conditions, sanitation, clean water are all important aspects that need to be taken into account with this list in order to improve the health of an entire population.
Moreover, I do think that with it is possible to balance profit-driven innovative incentives while ensuring that essential drugs stay affordable for everyone. In order to achieve this, government agencies will have to increase regulation on drug prices and stop certain pharmaceutical rights, like patents, that cause the rise of drugs and prevent the production of cheaper generic drugs. As you mentioned in your post, I think that this list does in some way allow pharmaceutical companies to maintain high-prices by labeling their drugs as essential. One way in which the WHO could regulate this could be to set a maximum price that the drugs on that list could not exceed, in order for everyone to have access to them.
Hi Claire! Thanks for your insightful comments! I really like your point about the importance of emphasizing better living conditions, sanitation, infrastructure etc. It makes me think about the McKeowen Hypothesis discussed in class. Medical interventions did not play a large role in improving human health, rather it was economic development that declined morality. Your comments lead me to question further whether it is useful to have a list of essential medicines. Who benefits the most by this list, the individual, or the population?
Furthermore, in response to your second point, I completely agree that the WHO should have an involvement in preventing monopolies on drugs. I just wonder if setting a maximum will provide enough incentive for pharmaceutical companies to create the most effective and innovative drugs? How do we still maintain a competitive market while preserving the welfare of the general public?
Your blog was very interesting and eye-opening as you brought in personal accounts from the internship you held in the summer of 2013. I think that this is a very important aspect of global health, since the implementation of this list of essential medicines has caused oppression amongst populations with poverty.
The definition of ‘essential’ is very important, as it can both help and strain certain communities. In my opinion, the word ‘essential’ should be defined in relation to its effectiveness and affordability. While the list of essential medicines has caused some strain on certain populations, I think it is important to have such a list. By implementing this list, the overall population will be better off, and this list may be a stepping-stone for other health initiatives to come. While I think that this list is useful, I am aware of the oppression it can inflict, and therefore I think it is especially important to have an agreeable and effective definition of the word ‘essential.’ I think it would be beneficial for the WHO to modify its list. In doing this, the WHO should consider all parts of the population, and measure the effectiveness that certain medicines have had.
To answer your second question, I do believe that it is possible to balance profit-driven incentives with a desire to improve the common good. To do this, there needs to be heavy regulation of the effectiveness of ‘essential’ drugs, and there needs to be regular measurements of the outcomes of these drugs amongst the population. Part of this measurement includes the affordability of these drugs.
I think your post is very informative, and I believe that this is a crucial aspect of global health, as it effects every part of the population, and has the ability to both cure and cause strain on certain peoples.
Thank you very much for your wonderful and thought provoking comments! I love the way you phrased the statement that essential medicines can both “cure and strain,” populations. It is interesting to note how essential medicines can inflict structural violence and widen inequities – affecting the poorest and most underprivileged populations. As you suggested, the definition and connotation of “essential” needs to be greater discussed. I wonder what criteria the WHO could use to determine if medicines are “essential” or not? Would the criteria differ from nation to nation? Debating this definition would ensure considering the perspectives of pharmaceutical companies, governmental leaders, non governmental organization, and most importantly- the voices of the most poor and underprivileged.
Thank you for your response! You bring up a great point – the definition of “essential” may change from nation to nation, as some illnesses and diseases are more prevalent in certain populations. I suppose that to make an “essential medicines” list effective, there would have to be a separate list for every country, which should incorporate knowledge of what diseases and illnesses are prevalent in these nations. However, there are many unintended consequences that may result from this. Do you believe that this would be effective? Or is it better to just eliminate this list?
You bring up some great questions. When I think about unintended consequences and the effectiveness of mechanisms such as an “essential medicine” list, I can’t help but think back to Alma-Ata. Alma-Ata did not bring about any concrete change, but did set an overall global tone regarding the importance of health. I wonder if we should consider the list to be more of a flexible guideline- one that continually adapts to changing market and health environments. This guideline could help individual governments, pharmaceutical companies and NGOs place priority on important treatments. Obviously, even this could bring about unintended consequences.
I think that having some sort of a guideline could help each country focus and direct its efforts towards solving prevalent health problems.
I found your blog very interesting, especially your discussion of prioritizing common diseases over rare. While this is certainly problematic, I am curious if you (or anyone else) have an alternative. Going off of the utilitarian approach, which would promote the greatest good for the greatest number of people, it is a difficult argument to make that large amounts of resources should be invested in a rare disease if people are dying or diseased by easily treatable conditions. This is such a difficult topic because it prioritizes or values certain lives over others, which is not something I am comfortable with. Realistically, however, I do not really see an alternative, and the utilitarian approach is the best because resources are so limited.
In regards to your second question, I think it is difficult but definitely possible to balance profit incentives and a desire to help the common good. However, these might have to come from different sources, because pharmaceutical companies are unlikely to try to balance this on their own. Clearly, government regulation on drug prices and patents are an important part of this. I also want to discuss if it is possible for either the government or other groups to provide an incentive for pharmaceutical companies to develop less marketable drugs – for diseases that affect a smaller number – and how this could be a possible solution to the lacking research and development of technologies for rarer diseases. In tying this back into essential medicines, I think that while rarer diseases should not necessarily be the top priority, it is still important to try to develop medicine. This way, a set cost can be established, and considerations of this medicine can be worked into a prioritization framework and compared to others to see where the biggest change can occur.
Hi Leah, thank you for your thought provoking comments! You are absolutely right about the inevitability of a utilitarian approach, it is hard to think of alternatives. The conflict between the individual and population is one we’ve discussed in great length in class- and one that is difficult to find resolution to. In focusing on the population with the “essential medicine” list, which individual voices are silenced?
Like you, both Julianne and Claire have called for governmental action to ensure the affordability of drugs. I think it’s safe to say that the production of pharmaceuticals needs to have a balance between public and private sectors to ensure the common good is preserved. I like how you approach the issue of rare diseases as an important priority, but still of lesser importance than those affecting the majority. I agree with you that the new framework outlining the production and development of drugs should incorporate rare disease drugs as an important priority.
Thanks for your awesome insights!
Thank you for your post, I was able to connect with a lot of the points you made and found your discussion very interesting. I work with a rare neurodevelopmental disease, and many of the parents of the children suffering dedicate a lot of time an energy interacting with pharmaceutical companies trying to encourage drug research. It is very upsetting to see how little motivation there is from the pharmaceutical companies to work with these disease because there is simply no money in it. However, when I think the best approach to global health, I am torn. With limited resources, it seems like the best approach is to help the most people by providing drugs for treatable conditions. At the same time it feels wrong to leave those who are suffering from a rare disease behind, but I do not know how to balance the two.
In response to your question about essential medicines, I strongly agree with a point you mentioned in your post. In present day, I think that the list of essential medicines should be more regionalized. Like you mentioned, different regions suffer from different diseases and different struggles in access to healthcare. Working with countries to understand what they deem as “essential” seems like a better approach than generating a worldwide list.
In creating this list, I think that the most effective medicines should be considered, regardless of price. To control prices so that all countries can have access and pharmaceutical companies have less power, I think that there should be a set maximum cost for any drug on the list. Once a drug is place on the list, the price drops to an affordable level. This would require working with pharmaceutical companies, and while it may be difficult, I don’t think it is impossible. By dropping their prices, but staying on the essentials list, they expand the marketability of the drug, while maintaining a good reputation with the world.
Thank you very much for sharing your own personal experiences as well! The struggle you describe is one that is very difficult to solve- do we prioritize the needs of the individual or the population? Leah made a point earlier in the blog, that the “pharmaceutical care” system should be tiered. It should focus on first on providing drugs for the majority but should also provide secondary incentives for “orphan/rare disease” drugs to be produced.
I like how you mentioned in your next point that having the label “essential, ” improves the marketability of the drug itself. Perhaps this could be used to provide incentives to pharmaceutical companies, despite a maximum price being enforced. I wonder if governmental subsidies for drug research and development would also be beneficial for essential medicines. Further questions to think about are: what role does the state play in ensuring essential medicines are accessible? Do the UN and other NGOs have roles to play as well?
I really like the idea of a tiered system in theory but I wonder if it would work in practice. Its is inherent that with rare disease drug production, less people are working on the disease. This means that fewer researchers must dedicate more time and money just to understand the biology of the disease, much less produce a drug. With so many rare diseases and such limited money from government organizations such as the NIH, I wonder if the system would work for a little while, but then run out of funding and thus incentive for researchers.
I think it would be great if governmental subsidies for drug research and development were provided to pharmaceutical companies for essential medicines (outside of NIH funding). But this must also come with a guarantee from pharmaceutical companies that they will lower their prices as well. I believe that the real issue is pharmaceutical companies’ focus on profit, which makes sense because they are a business. However, as we have talked about in class, often business and global health efforts don’t work well together. Personally, I believe that the US government should have the biggest role in making sure that essential US produced drugs are accessible to the world. Organizations like the UN or WHO should be responsible for the overall affordability of the Essential Medicines List, communicating with countries where pharmaceutical companies are based to work to lower drug costs.
I enjoyed reading about your personal experiences with Rare Genomics Institute and seeing how that influenced your thoughts about essential medicines. Having that additional perspective is so important when trying to consider what is best for all different people with different conditions and illnesses.
I completely agree with you on your opinion of trying to create a blanket list of “essential medicines”, because I find it difficult to believe that conditions and prevalent diseases are the same in all areas of the world. I hadn’t thought about the barriers of access, and I appreciate these points you made that strengthened your viewpoint.
As I expressed in another post, I believe that perhaps there should not be an essential medicines list altogether. The idea of being able to provide everyone the medicine they need is undoubtedly good, but the execution through one overarching list gives rise to a multitude of potential problems. It creates controversy over which medicines should be on the list, competition to get on the list, and complications about generic drugs and varied pricing. The video you linked also provides another complicated layer of trying to fit in intellectual property rights when it comes to these medicines.
I always feel as though it is difficult to use “the common good” as motivation for progress, since it is evident that many people innovate and work for money. Ideally, helping people would be a good enough incentive, but realistically, there needs to be a more tangible reward for people to work towards. Perhaps government regulation of maximum prices or additional funding for the creation of affordable drugs can push pharmaceutical companies towards this goal.
You raise some very important points. Earlier on in the thread, Claire pointed out that focusing on economic and social development may in fact be more helpful to populations. In class we discussed the McKeown hypothesis, and how McKinlay & Mckinlay commented that economic and social interventions may in fact be more important than medical interventions when reducing mortality rates. I wonder instead of focusing on “essential medicines,” our priorities should lie with stimulating social and economic development in countries which need these essential medicines the most.
With regards to improving drug affordability, you make good suggestions about the government providing subsidies and/or changing market prices. Some further questions to consider when thinking of ways to redesign the pharmaceutical system are: Do you think NGOs and organizations like the UN have roles to play as well? With fluctuating economic conditions, how can we work towards setting a maximum price for essential medicines?
Thanks for your informative take on essential medicines from a pharmaceutical take and for including rare diseases. I think rare diseases are something that can get lost in this profit-maximizing world.
Something that I learned about in my public health class is the concept of ‘equipoise’ which is a general uncertainty as to whether one treatment is better than another. To undergo a clinical trial, equipoise has to be evident, otherwise, denying someone a treatment that is likely better than another treatment is unethical. I think this could apply to the list of essential medicines. You mentioned how there’s an inefficient way to add new medicines to the list of “essential medicines,” well if the newer drug is more effective and has undergone some sort of human testing already, I think that it should be on the list of “essential medicines.” As for whether it’s still necessary for this list, I think because we live in a world of formalities and analytics, money would not be given to a project if the medicine is not on the list. So unless the thinking is changed, it should be easier for more effective drugs to be on the list and it would be less based on previous establishment.
If the Trans-Pacific Partnership allowed competition among generic drugs, I think drug prices could dramatically decrease. Incentives for pharmaceutical companies to innovate new solutions would be that a grant could be given to provide drugs from rare disease if the pharmaceutical company created an effective drug that was reasonably prices. I also wonder whether a concept like pooling in health care could work. For example, all of the sick and healthy people must buy insurance in order for the healthy people to help off-set the cost of the sick people in the US. I wonder if once competition of generic drugs lowers the price, if it could be raised just a little to help fund more expensive drugs for rare conditions.
Thank you for the fresh perspective you brought to the discussion! I love how the concept of “equipoise,” brings to light the inefficiency of the current “essential medicines” list. In regards to your response for the second question, promoting competition among generic drugs would be the best way to ensure that essential medicine prices stay low. You bring up some neat ideas regarding how to reallocate funds to ensure drug prices stay low- I had not thought of that before! Would it also be effective to have government sanctions to help regulate competition?
The issue with the TPP is that it would lower competition levels, posing a threat to the poorest and most vulnerable members of society. Exorbitant drugs can create immense structural violence, disproportionally affecting those lying below the poverty line. Agreements like the TPP are forged between very powerful countries, how do we ensure that they have the best interests of populations which are not in positions of power? In the course, we critiqued the effectiveness of organizations like the WHO and World Bank. Do you think they could help regulate such agreements to ensure structural violence was not a result of initiatives?
Thank your for your post! I really enjoyed reading about your personal experiences at your internship.
Though I agree with your statements and feel as though there is a moral obligation to also help those with rare conditions, and your personal anecdote definitely brought about a sense of obligation. I would ask how you can reconcile this with a more utilitarian approach, where the greatest good for the greatest amount of people is prioritized? I think this also relates to what we discussed in class about cost effectiveness and dividing the pie in the best way possible. I’m not sure there is a way, but I believe it is something worth considering, because while it may seem impractical with how the system is now there can be restructuring that can make development of treatment for rare diseases a possibility even within a utilitarian model.
To attempt to answer your second question, I think , it might be too optimistic but that it is a possibility to create a system incentives, that can basically balance innovation with the moral obligation to the common good. The Trans-Pacific Partnership seems like a good step that could definitely go a long way in lowering the cost that will definitely improve access. Even if pharmaceutical companies themselves have other motivation besides the greater good, if the right incentives are put into place, the decision that benefit the company and people suffering can be aligned.
This is not an easy task however, there is the problem of who should be creating these incentives. I believe government organizations would probably have the greatest success and have the greatest obligation to protect their citizens from disease and regulate the pharmaceutical companies and drug prices. I understand, however, that lobbying takes place and big pharma because of big money has a lot of power. Do you believe that other organizations can play a governmental role and provide incentives that regulate the self-interest of pharmaceutical companies?
Thanks for your comments, you raise some very important questions! Leah, Julianne and Claire also brought up the fact that a new model of drug production could be both utilitarian and ensure that rare disease patients were also given priorities. It is possible to do it all, rather than settling for one or the other. I think most posters on the blog would agree that incentivization is the key to solving the pharmaceutical fix.
It’s difficult to say who should create these incentives- it should really be a multifaceted effort. Governments must set regulations, pharmaceutical companies must practice corporate social responsibility, and authorities such as the WHO/World Bank should play a greater role in regulating the actions of G8 countries. However, as we discussed in class, there are several problems with the operation of the WHO and World Bank. Restructuring our pharmaceutical system will involve setting aside hidden agendas and working towards the global health priorities discussed in Alma Ata.
Hi Divya! I don’t know if I’ve been living under a rock or something, but your post is the first time I’ve encountered any news of the TPP. And I agree with what you’ve said–it’s extraordinarily unfair that the pharmaceutical companies can exercise so much power in a realm in which so many people are being negatively affected. Even when pharmaceuticals agree to lower prices or give out a free supply of medicine, the very nature of pharmaceuticals as a profit-driven industry places such aid on unstable ground. Such aid cannot be sustainable, can be rescinded at any time, and is ultimately at the discretion of market forces.
Personally, it seems to me very difficult to imagine how profit-driven incentives can ensure (with complete guarantee) the affordability of drugs. There seems to be so many external factors that hinder any sustainable action on part of pharmaceutical companies, being so driven by a constantly changing market.
When I think of plausible solutions to this problem, I actually think to our current environmental crisis. I remember studying that manufacturing companies have the ability to buy “credits” that allow them to emit a certain amount into the atmosphere. If they emit more, they have to pay extra costs. If they emit less, they build credit. I learned about this in my AP Environmental science class years ago, though, so this may be different or not exist anymore.
Anyway, I think it would interesting if we saw pharmaceuticals under a similar system in which a certain amount of their production must go to the development (and affordability) of drugs for populations that express great need. If they don’t, richer countries might sign an agreement to go to a pharmaceutical company that does address high-need populations. Of course, this might create problems of its own. Who to enforce such a system? Who will refuse to buy pharmaceuticals when high-need populations aren’t being served? Like we’ve talked about in class, WHO doesn’t have much teeth. So, the ability to ensure such a plan becomes wholly dependent on the willingness of rich nations.
I loved reading your proposed solutions to this issue. You are completely right in that market forces alone should not govern accessibility to drugs. External forces are unpredictable and therefore should not determine prices of essential drugs. There needs to be some involvement from the public sector to ensure stability. The AP environmental class example was really interesting to read about. An incentive system like this needs to be built surrounding pharmaceuticals.
You bring up an excellent point as to who exactly should govern this system. In class, we’ve discussed how entities such as the WHO/World Bank/UN do not have much say in global politics. There needs to be unified global agreement on tackling this issue. Yet, I think back to Alma Ata and how it did not lead to concrete action. It’s sad to say, but do we have hope that countries in power will decide to protect the most underprivileged of populations? I want to be optimistic and say that if people like us take a stand, one day, there will be global unity surrounding this issue.
I like your point about how we cannot (or should not) create a blanket list of medicines deemed “essential” in every country—all country’s medical needs are different, so each country may need different medicines. That seems to me to be one of the main issues with the Essential Medicines list.
And the point you make about your summer research is fascinating—people with rare diseases are really left out of the picture if what they need is something other than an “essential” medicine.
I’ve been thinking a lot about your second question and your statement, “It is not ethical to have a system where corporations and market-driven governments profit from causing misery and death.” The pharmaceutical industry has become so prominent and profit-driven that it takes advantage of people who are ill or are even just worried about their health. Greene even writes that pharmaceutical companies advertise “in an attempt to coerce physicians to prescribe their more expensive brand-name products” (18). In addition to examples in which physicians prescribe brand-name drugs rather than generics, I’m particularly struck by the example of prescriptions of statins for keeping down cholesterol levels. I don’t deny that statins are important and can even be life-saving, but it seems to me that the industry and medical field scare currently healthy individuals into taking pharmaceutical drugs for the rest of their lives, to prevent an adverse event (a heart attack, for example) that might not even happen. While no one wants a heart attack, it seems that pharmaceutical companies take advantage of peoples’ gullibility and fear in order to make a profit. So ideally, pharmaceutical companies could operate in a way that isn’t profit-driven—but I don’t know if that is possible in our current global economy.
You bring up some great points for consideration. After reading your thoughts, I wonder whether essential medicines should be privately regulated at all. Your example of statins remind me of the cigarette epidemic example we discussed in class, where doctors were supporting tobacco companies in their efforts. As discussed in class, corporate power in health makes me uneasy.
Do you think organizations such as the WHO and individual governments should be responsible instead? How can we work towards preserving innovation in a non-profit system? And as you hinted, is it even possible to change our current capitalistic system?
I really enjoyed your post about the problems of essentializing medicine. I appreciated your insight on the problems of rare-diseases an the lack of attention that is paid to them. Although I completely agree with the problems of the WHO’s list of essential medicines, I wonder what the alternatives are. If there was no essential medicines list, then this might run the risk of eliminating some drugs that are extremely crucial to health. I think the word essential should be define differently for each situation, in other words I don’t think that there can be a universal agreement about what “essential drugs” should consist of. Due to this, it is difficult to say how the WHO should re-modify their essential drug list, since with each modification there will continue to be problems that are not addressed for specific situations.
For reasons like this, I believe that it is difficult for international organizations to come to a clear consensus that would not have any unintended consequences. The question of what to do to improve the essential drugs list dilemma is still unclear to me, but I think that it should start with a personal approach for each country.
Thanks for your comments! As I said in my blog post, a personal and specific approach for each country might be best for essential medicines. As mentioned in class, the concept of “local biologies,” shows that biology is significantly related to culture. It is therefore important to target specific approaches for each country. Do you think organizations such as the WHO and UN should play a regulatory role in monitoring these country-specific lists?
Thank you Divya for your post,
I really like the point that you make in your post. In my opinion essential should be defined as something that one cannot live without. I don’t believe that it is totally necessary to maintain a list of 186 “essential” medicines, however I do believe that there is a fair amount of good that this list could do. I see the intent of this list to create a demand for these drugs as more and more people are given access to them, and with this I believe the WHO thought they could lower the cost of these drugs. You are definitely correct that those suffering from rare diseases are not receiving any benefits from this very narrow list of drugs and for that reason I believe that the WHO should expand this list to encompass as many treatments as possible. By making these less used medications more available and increasing a demand for them, hopefully there price will be lowered, but, most importantly, those that need them will be given access to them.
Your second question is very saddening in that in a capitalist system I believe there is very little that can be done to persuade companies to reduce their profits. The only real solution I can think of is the price of the drugs being set by a neutral governing body not associated with the companies. However, your point of innovation is very interesting, and I believe this might hinder it. Unless drug research becomes subsidized from the public sector I believe there is little to do to increase innovation.
You make a really important point about an “essential medicines,” list actually incentivizing drug companies to innovate. Having a list, shows there is demand for the drug. Yet, tragically, the current system involves pharmaceutical companies still charging exorbitant prices for drugs. The overall consensus on the page seems to be that the public sector needs to play a role in regulating the prices of these drugs. The question is- how will governments have leverage over powerful corporations? Can we create movement similar to the anti-smoking campaign, where corporate motives were silenced to ensure health was preserved as a human right?