Expensive Essential Medicines: The Return of the “Appropriate Technology” Dilemma

The WHO recently widened its list to include new (and costly) treatments for cancer and Hepatitis C in a move that opens the way to improve access to innovative medicines that show clear clinical benefits and could have enormous public health impact globally.”(WHO). Emphasis on the “could.” While these new medicines have been deemed highly effective and safe,  they are extremely expensive; they can cost from $63,000 to $94,500, “depending on the drug and regimen.” (Silverman). These new drugs do make curing Hepatitis C a reality, but how realistic is it to make these newly minted essential medicines available and affordable on a global scale when we still struggle to provide consistent access to the more affordable essential medicines and other basic health rights, such as clean water?

Whether it is idealism that placed these drugs on the list of essential medicines or not, the placement of these new and expensive drugs on the essential medicines list is a mark of the huge disparity and inequality present in global health. Simply conceding that  some “uniform measure” to lower the prices of these essential medicines needs to be put in place in order for the health benefits to come to fruition is not enough to justify the decision to sponsor these drugs (in a way, putting a new drug on an essentials list is a form of advertising…).  

Farmer argues that we fall back too often into low-tech solutions  because they are deemed “appropriate,”  and “sustainable” instead of providing high quality treatments and care, even though both are needed to improve health on a global scale (Infections and Inequalities 21). Making a list of essential medicines attempts to encourage providing higher quality treatment, but including expensive therapies in an “essentials” list without any clear direction as to how their cost can be lowered continues to perpetuate the low-tech approach to improving global health. I would even argue that it is counterproductive to prioritize these new Hepatitis C and cancer treatments, though they are new and effective, if more affordable, newer (though not the newest) medicines exist and have yet to be implemented. Quite the opposite of blazing a trail in global health for innovative medicines.

More importantly, making new pricy therapies essential could jeopardize the funding for providing other basic rights: “On paper, essential medicines joined clean water, adequate housing, and a safe food supply” in a list of universal human rights (Greene 11). These rights lead to better health outcomes, but essential medicines weigh more heavily than due their higher relative expense and (more) immediate benefit. Additionally, these new and innovative drugs are so costly that providing them would logically come at the expense of providing other essentials, such as clean water and adequate housing, in a global health delivery. It seems intuitively wrong that a basic necessity would come at such a cost. This being said, if the prices were to be successfully lowered, the benefits alluded to in the WHO report would then be twofold: lowering the cost would make the medicines more accessible in general and would lower the competition between essential medicines and basics like clean water and housing for funding and attention.

Access to medicine and to care is essential, clean water is essential, safe housing is essential, food is essential… but prioritizing one essential  over the others in our approach to Global Health implies that some of the essentials can be overlooked, and are therefore secondary to that essential that takes precedence, whether that is effective drugs or sustainable changes to the infrastructure.

Questions for discussion:

  1. When do the essentials stop being essential? Does prioritizing one negate the others?
  2. Should the list of essential medicines be narrowed or done away with entirely?
  3. Should there be a system of weights that prioritizes more affordable medicines? What about more effective ones?
  4. How should the human rights relating to health listed by Greene be weighted, if they had to be weighed?

 

Works Cited:

Farmer, P. (1999). Infections and inequalities: The modern plagues (p. 21). Berkeley: University of California Press.

Greene, J. (2011). Making medicines essential: The emergent centrality of pharmaceuticals in global health. BioSocieties, 6(1), 10-33.

Silverman, E. (2015, May 8). WHO Adds Gilead Hepatitis C Drugs to its List of Essential Medicines. Retrieved November 2, 2015, from http://blogs.wsj.com/pharmalot/2015/05/08/who-adds-hepatitis-c-and-cancer-drugs-to-its-list-of-essential-medicines/

WHO moves to improve access to lifesaving medicines for hepatitis C, drug-resistant TB and cancers. (2015, May 8). Retrieved November 3, 2015, from http://www.who.int/mediacentre/news/releases/2015/new-essential-medicines-list/en/

 

23 thoughts on “Expensive Essential Medicines: The Return of the “Appropriate Technology” Dilemma”

  1. Hi Sylvia,

    I found you post very interesting and informative, especially when you talked about the hierarchy that global health and the WHO have set up to prioritize one issue over the other. I also found the example of the Hepatitis C drug’s price very shocking and it illustrates how important it is to have more affordable essential medicines.

    Concerning your first and second questions, you raised the very interesting point of how having a list of essential medicines makes other medicines less essential and how prioritizing one issue implies that we can overlook others. I agree with your point in that all essentials need to be seen as priorities in order to improve the health of an entire population. However, it can be difficult and somewhat utopic to think that we can prioritize all of these issues at the same time with the support and funding these programs are getting right now. I do think that the list of essential medicines is a good concept in trying to give people access to the medication they need but that they should try to narrow it down to medicines that are affordable to anyone instead of bringing in new drugs that are not even proved to have a large scale impact on the health of a population.

    As I mentioned previously, I think that we need to take every health and living conditions into consideration before implementing a health measure. Looking at the human rights relating to health listed by Greene, I think that medicine can only help with curing the disease itself but if we do not change people’s living conditions, sanitation, food sources … these diseases will remain present in the population. This is why I think that these human rights relating to health need to be weighed heavily in this battle between public health and pharmaceuticals.

    1. Hi Sylvia,

      I found your post to be very interesting and you raised many good points. To answer your first question, the ideal situation would be to prioritize every essential. However, that is not realistic. The essentials stop being essential when the WHO prioritizes the costly medicines over the affordable medicines. In relation to your second question, I think it is important to have a list of essential medicines. Since prioritizing some medicines can negate others, it is important to narrow down what medicines are realistically essential.

      I think it is more practical for the list of essential medicines to consist of medicines that have proven to be successful and are also affordable. Implementing expensive medicines that have not yet proven to work will do more harm than good on an economic level. While it may be hard to go about such a system, I think it would be beneficial to have a system of weights that prioritized affordable and effective medicines.

      Concerning the question you raised regarding to Greene’s idea of human rights related to health, I think the most important part of human rights is the accessibility to medicines. While sanitation, living conditions, clean water and safe nutrition all affect one’s health, the most important aspect of human rights relating to health is being able to access medicines to cure illnesses. I think the most practical way to approach this issue is to address the accessibility all persons have to essential medicines.

      These are all very good points, and while going about such issues is difficult, in the long run, the general population will be better off.

      1. Hi Julianne,

        Introducing a system of weights like the ones you suggest does beg the question of appropriate technology (to reference the title of this post). Limiting the list to what is both “appropriate” and “essential” does narrow the focus to making specific medicines accessible. You also seem to be placing what is realistic over what is needed–and that may not be so realistic. I think that the biggest issue is not the fact that these high priced medicines are placed on the list, but that nothing substantial has been done to lower the prices of these drugs and that maintaining essential medicines that are so costly is to the detriment of improving health outcomes, (especially for illnesses that are chronic, rare, and/or cannot be easily treated) and quality of life. Unless you’re arguing that quality of life and health are somehow separate from each other. Sort of a McKeown hypothesis in reverse…

        You definitely make some strong statements–that making medicines accessible is the *most* important aspect of health. Frankly, I don’t agree. We’ve learned that health is more than just the “cure”–what about prevention? pain relief? social factors? suffering that can be alleviated or prevented by improving infrastructure? Granted, treating and curing disease is an essential aspect of global health– yet if all the drugs in the world were *accessible*–would we really be better off? What about not just accessible but affordable?

    2. Thanks for your comment, Claire.
      Admittedly, controlling the medical/pharma economy is very utopic-world-communism vibes. What about a place like Brazil? The human right to health is guaranteed by the government, but drug prices are ridiculously high and the only way to get access to them–especially drugs for chronic conditions, less common illnesses–is through the judicial system, as shown in When People Come First.
      To put it more bluntly, prioritizing = overlooking things for the sake of focusing on whatever it is that has been determined a priority. I’ll add to your argument for human rights relating to health that pharmaceuticalization also makes it seem like a problem is gone or fixed, when the causes of that problem are still present and have not been addressed–i.e., the pharmaceuticalization of social suffering.

  2. I think you made some really important points regarding the prioritization of things considered “essential,” both medicine and human rights. In response to your second question, I do not think the list of essential medicines has to be eliminated because it is a good starting point. However, I think that it must be looked at more realistically, and worked into a larger framework. This ties back to your discussion of how to prioritize when so many things are considered essential, not only medicine but also clean water, food, housing, and so much more. I think the most effective approach is to break the list of essential medicines down into individual medicines/diseases being targeted, and prioritize each of these within the framework of all the other human rights and essentials, like food and water.

    Another point you brought up is that prioritizing certain essentials gives them precedence and takes the focus away from others. While this isn’t ideal, I think it is necessary. Change must start somewhere, and you cannot tackle every problem at once. Prioritizing is so important because, if done right, it creates the biggest change with the least time/ resources /limiting factor. If key structural changes are made, then other less essential essentials, like more expensive medicine and treatment, can work their way into the top priorities.

    1. Thanks for your comment on the importance of prioritizing, Leah. Kind of makes me think of why SPHC worked while PHC was “dead on arrival.” Wouldn’t it be more helpful to start from scratch, then? What if there is more than one drug for one condition? Your suggestion of using the essentials list as part of a broader approach is a great example of a diagonal approach, I think.

      You say “less essential essentials” which is like saying “less fundamental fundamentals”– exactly the sort of phrase that I critique in the post. Your comment and others imply some spectrum of essential-ness, which I find to be a misuse of the term essential. There is, clearly, a spectrum of convenience and cost when it comes to what is determined “essential”–what I do wonder is if there is or should some point of cost and complexity that an essential should no longer be referred to as such… The general hesitance to set a boundary of essentiality (maybe above a certain cost or commitment, for example) and to take that bullet and say that “no, this or that expensive treatment is not (presently) an essential” (feel free to replace “essential” with “a priority”) implies that if we don’t call something essential, it won’t make it to the priority list at all.

  3. Hi Sylvia,

    Thank you for your post, I found it very informative and thought provoking. I was very interested in the information you provided about the Hepatitis C drug, that is on the essential medicines list but too expensive to realistically provide on a global scale. In response to your question, I think the best way to provide medication is to prioritize the most effective medications that are proven to work, rather than including the newest drug that a pharmaceutical company may be trying to advertise, and thus discounts. Furthermore, although I think the list of essential medicines is a good starting point, I think it is too general to apply on a country by country basis. I think a more effective approach would be to generate lists based on what a country feels are its greatest medical needs. While this may be unrealistic, I think that having a essential medicines list for the whole world is too broad and should be brought down to a region by region level in order to have the greatest impact.
    With all our discussion on essential medicines, you bring up a great point, that many developing countries are still struggling to provide clean water, basic healthcare, sanitation and nutrition. Ideally, the best approach would be to prioritize all of the essentials, however this is likely too optimistic. Luckily though, I do not think that dedicating more resources to one aspect of health negates the importance of all other aspect. Realistically, I think the best approach may be targeting access to medication in order to try to prevent infectious and avoidable diseases. Creating an overall healthier community based on access to medications could make prioritizing clean water, food, and safe housing more successful and show these communities we are committed to helping them.

    1. Thanks for your comment, Sarah.

      Tailoring the essentials list may address region-specific needs that would be overlooked by a world list, but it would make it a challenge to decide on a supranational level on which interventions to take, which medicines should be made more accessible. Another question is whether we want to decide essentials based on borders (country-by-country)–that could get manipulated by political agenda.

      I wonder how breaking down the list into region-by-region would lead to a greater impact–it could also dilute the waters so much that priorities are lost entirely; it’s a tender balance, right? Those other essentials–food, water, housing–they are universal and fairly straightforward. These essentials and the need for them doesn’t change based on region or country.

      I mention in another comment that there is a disconnect between essential medicines and pragmatic solidarity–namely, that health literacy is lacking in a lot of these places and they may not be capable of determining the medicines that are needed the most because there aren’t the intellectual and/or human resources to make diagnoses, for example. While health literacy is not mentioned by Greene as an essential, it seems like an important piece of the puzzle when it comes to determining what a community needs. The following question that comes to my mind: what kinds of knowledge (and *bio*power) could our own narratives on essential medicines be perpetuating…? Just a thought.

      1. Hi Sylvie,

        I agree that establishing a list on country by country basis could be heavily influenced by corruption, however I think having a worldwide list implies that everyone all over the world experiences the same health issues, which is not true. There would need to be a way to communicate with the local people rather than just the government to understand which diseases have the greatest impact on their daily lives. By having people on the ground, communicating with locals, this could be one way to combat the health literacy problem you mentioned. The local communities could show the symptoms they experience rather than understand and name diseases, and the health care workers (likely from NGOs) could identify the diseases. By working with the communities and asking them what they need, pragmatic solidarity can be applied, and our own (Western) narrative could remain out of the discussion as much as possible . Take for example Sierra Leone, where lots of resources are dedicated to helping those with HIV/AIDS even though a very small portion of the population actually suffers from the disease. If such a technique was applied to Sierra Leone, efforts could be made to change priorities and bring in more medication for malaria, which affects a greater number of people. Essentials such as food, water, and housing are a different area all together, there should be no list for them- they should just be provided and an inherent right. With pharmaceutical companies, providing medication for free does not seem to be so straight forwards.

  4. Sylvia,

    Thank you for really diving deep into the word “essential” and analyzing what that truly means. Like you said, so many elements are essential to health such as food, water, housing, access, etc.. but if they are essential, everyone should be able to obtain them. If something is pricy, how is it essential, since not many will be able to afford it?

    As soon as I started reading your post, I too felt as though perhaps these medicines were put on this “essentials” list almost as an advertisement. We see this type of marketing strategy on so many products–essential vitamins and minerals in our cereals, essential oils in our cosmetics–and it pushes this sense of necessity and urgency. While these medicines may be necessary or urgent for some people, it may not be for others, so perhaps the idea of one umbrella list of essentials for the entire world is not feasible.

    I feel as though I’m playing with the idea that the essential medicines list should be done away with entirely, simply because one country’s full list of essential medicines can’t always match another’s. Greene’s list of human rights I can agree with–food, water, shelter, and medicine. Medicine that is truly essential for specific countries and people.

    1. Thanks for your comment, Thu. I appreciate your take on the meanings of “essential” that my post plays with. I hadn’t thought of how essential is used in those other contexts, but it definitely fits the narrative of urgency that you’ve mentioned and that has incited my concerns.

  5. Hi Sylvia,

    I think it’s great that you challenged what ‘essential’ means in a global context. I think it’s important to question how high-cost medicines could impact other areas of global health.

    To answer your first two questions together, I think a list of essential medicines should not be done away with, but should also not be held the same everywhere. Having a list of essential medicines says that every area of the world has the same health problems and diseases, which is not the case. I think that some medicines may be ‘essential’ in one place, but not in another. For this, I think that the list should maybe be done more by country or region. Though this is probably not realistic, it should not place some medicines over others. The prioritization of medicines should be up to the country to do, as they hopefully know what diseases are affecting their population.

    In placing essential medicines on the same field as other essential rights, like water, food, and sanitation, I think it is important to prioritize by the need of the community. For example, when planning my to-do list for homework, the most immediate, important items go first, and then the ones that are due later or might be for classes not in my concentration goes later. For addressing health and basic human rights, I think one has to prioritize the interventions that will help the most people and are maybe effective more immediately first. Though ideally we could fix everything at once, this isn’t the reality of the world. How could expensive Hepetitis C drugs be given if the people taking them don’t have enough food? If more affordable medicines can be given to a lot of people, is it right to deny them medicine to save a few people using a more expensive medicine? While I think everything is ethically challenging to decide in the world of global health, one does have to take into account how well the intervention is proven to work, the cost, and how people are affected by it. In this case, I think it’s up to local governments to work with NGOs and the WHO to tailor interventions to their areas.

    1. Thanks for your comment, Katherine.

      What about lowering costs and making priority medications more accessible? I don’t really go into this in my post, but this is something that requires a supranational authority, or at least international cooperation between the corporation and its nation and the nation that requires its medicines.

      I mostly agree with your second point. But can the individual communities and local governments really decide? Pragmatic solidarity and essential medicines aren’t exactly compatible. We talk about the importance and necessity of health literacy–but what about communities that are suffering, but don’t know what ails them? So here’s another issue that comes with having to decide on essential medicines, even though it is very helpful for prioritizing…

      Those classes that aren’t part of your concentration do appear less important and arguably less essential.The visible action (putting aside the other classes every time) implies that one (your classes in your concentration) is more important and essential than the other. And this has the potential to create a certain narrative that grants some things more essential than others (sort of like the Orwellian “all animals are equal, but some animals are more equal than others).

  6. Hi Sylvia,

    Thank you for your thought provoking post. I very much agree with you that this is another instance resurfacing of the” appropriate technology” debate.
    To answer your first two questions , I think it comes down to the issue of what is realistic and what is idealistic, and where we can draw the line. Ideally, all medicines that are effective no matter the cost, and all other human rights can be provided, but realistically this isn’t doable, and that is where this essential medicines list comes into play. Although, I will definitely critique this system, like we do much in class and section, I believe it is also a necessary starting point. It just shouldn’t be the end all be all, there needs to be more complex thought that should be put into what is the best way to intervene in global health. I also strongly believe that the list, though it can have a global component, there are going to have to be specific adjustments depending on the place.

    In response to your last question, I think there needs to be a system to weigh the humans rights that Greene discusses, arguably these issues fixed would provide better and more sustainable health outcomes. The problem is that this issues are more structural and complex. The treatment and curing of people with certain diseases is the more direct way to see outcomes.

    1. Thanks for your comment, Yilena.
      Of course, not all of these things are doable all at once, but I think the prioritizing becomes more complex when we use terms that are very strong–such as “essential”, which describes an absolute, extreme level of necessity. The other side of essential is that it implies something is basic, fundamental, yet the length and complexity of the list of essential medicines seems to go against the definition of an “essential.” Unlike the other health rights that Greene mentions, the necessity of certain medicines can vary so greatly from place to place. yet it seems easier to guarantee access to specific medications, despite how complicated pharma is, than it is to guarantee something that appears to be fairly straightforward and universally applicable–like clean water.

  7. Hi Sylvia!

    Like you, I am a little concerned about the addition of the expensive Hepatitis C to the list of essential medicines. To an extent, I agree with Farmer and his idea that we shouldn’t limit the medicines we use simply because of cost. If the medicine addresses a high need, has weak generic equivalents, and is proven to be effective, then it should qualify for the list. After all, the point of putting the Hepatitis C medicine on the Essentials list was probably to drive it to an affordable price so that it is available to populations who do not have the resources to buy it.

    At the same time, “high needs” are expressed differentially across villages, cities, regions, and countries. Claiming that an expensive Hepatitis C medicine is more essential than HIV medication in a region where AIDS accounts for significant mortality is to homogenize the very different needs of the world. Still, I agree with Katherine: the essential medicines list probably should not be done away with because of the basic framework which it supplies. But are there ways of making it more relevant to specific contexts? Weighting the essential medicines list according to country or region will allow pharmaceutical companies to make medicines such as the Hepatitis C available at a lower cost given that only certain areas express the need for it. At the same time, a high need in one area does not mean that the problem is nonexistent in other areas. And so, weighting medicines according to region presents its own set of problems.

    1. Hi Lilian!
      These are some really great points. I hadn’t thought of the concept of keeping the pre-existing list, but making region-specific weights. Clearly, this presents its own problems–which I attempted to point out in my general criticism of the potential issues and problematic narratives that can come out of essentializing and prioritizing some things more than others– some medicines more than other medicines, or some other human essential that contributes to the glaring inequalities in global health.
      I hadn’t thought of the other possible motive behind placing a medicine on an essentials list–not to advertise it, but to attempt to lower the price. Still–I can’t help but feel that a place on an essentials list is a major bargaining chip for a drug company when it comes to how they price their drug –like, they’ll have a customer no matter what, so lowering prices is not in their best interest and they can threaten to take their product off the market, etc.

  8. Hi Sylvia,
    I really like your post. I think it’s great that you question what it means to be “essential”—you make a really good point that adding expensive treatment drugs to the list of Essential Medicines has the potential to draw both funds and attention away from other important aspects of health care, such as primary care and disease prevention. As you mention, healthcare can be very expensive—especially fancy, novel treatments—and drawing focus away from primary care and prevention can lead to increased spending on these treatments, which would further contribute and support the already very expensive models of medical care.
    I’ve been thinking a lot about your second question—should the Essential Medicines list be done away with or narrowed? I don’t think it should be completely done away with. There have been instances—in the case of HIV/AIDS, for example—in which the fact that some medicines were enumerated as “essential” critically helped distribution of the drugs to places where they were much needed. So the list was useful there, without a doubt. But, I think the nature and culture of health and medicine varies so much from country to country throughout the world, that maybe the list needs to be slightly different either for each country, region, or at least by category of country (developing vs. developed, for example). And I think it’s important that doctors and health officials of developed countries are not the ones setting the lists of essential medicines for developing countries. I think the lists need to be much more catered to each country’s needs.

  9. Hi Sylvia,
    I really enjoyed reading your post on essentializing high-cost drugs. I agree with the points that you brought up about the dangers of invoking costly drugs in underdeveloped countries. However, I also think that there is danger in disregarding the benefits of having expensive medicines as part of the essential needs of an underdeveloped country. If only inexpensive medicines were thought to be essential, then a lot of the high technology therapies and pills that can alleviate suffering will no longer be even considered for implementation in lower income countries. The cost-effectiveness would overpower the medicinal benefits, creating a system where the poor stay sick, and only the rich have access to the best quality of medicine.
    In response to your second question, I do not think that the list of essential medicines should be done away with completely. I think that that would create the danger (as I hinted in my first paragraph) of having cost-effectiveness overpower the health and well-being of individuals in impoverished countries. Without a document that specifically lays out the necessary medicines, there is nothing to fight the argument that for example, ARVS are just as important as tuberculosis medication. The claim can made that certain medications are necessary for health (when in fact they are) and thus can be skipped because of the lack of cost-effectiveness. With a specified list there is a greater chance of obtaining medicinal equality.

  10. Hi Sylvia,

    I was intrigued by the idea presented towards the end of your blog post. The idea that prioritizing one essential may negate others is a concept that I had not considered before. I definitely think that essentials like water, food and housing should be addressed to the best of our abilities. However, if I had only enough funding to address one, would it negate the others? I think the answer is probably not…because food, water and housing are all relatively equal on the essentials list. Furthermore, they all go hand in hand. It is difficult to ensure an individual’s safety with only one of these essentials but not the others. Thus, in my mind they all hold the same level of importance.

    So then the question becomes is where do pharmaceuticals fit in in this essential list? If we assume that pharmaceuticals are less essential than water, food and shelter then prioritizing pharmaceuticals would blatantly be overlooking other more important essentials. I definitely think some pharmaceuticals are just a helpful and probably as integral the more basic essentials. These pharmaceuticals would be ”fair” to provide. The real issue here is that concerns like clean water, availability and safe housing all involve structural commitments. Pharmaceuticals on the other hand are usually a quick and easy fix. Thus pharmaceuticals that are not essential are prioritized because of their convenience. So my answer is yes, to a degree doing this overlooks other concerns. By giving people pharmaceuticals you mask the real situation at hand making it less likely that people will do something to address it. However, structural issues take a longer time to fix. Meanwhile people are suffering. Even if a medicine is not really essential, it seems almost immoral not to provide the medicine to relieve short-term pain. This makes jurisdiction over “what is essential” a lot harder to make.

    1. Thanks for your comment Derana!
      You make a really important point about the relative simplicity and efficiency of providing a drug in contrast to making structural changes. Wouldn’t you agree, however, that prioritizing drugs because of their convenience is wrong and an abuse of the term “essential?”
      These are no short-term pains and there is no short-term fix. I’d agree that not providing a medicine for reasons of cost and economic return is immoral, but a lot of the treatments on this list are treatments, not palliatives, thus they may cause suffering and their side effects can cause more pain than the condition itself (i.e. cancer drugs). I find“short-term pain” comment problematic–some of these drugs can cause suffering in and of themselves without proper supports (such as IV’s and pain relief medications), some will require infrastructure (therefore they imply a commitment–sort of like Benton’s “nail soup” concept), and what about chronic conditions?
      I want to repeat that providing medicines and vaccines (also essential), *does* require a structural commitment–perhaps an even greater one than providing concrete floors or a pump, for example. That’s the beauty of strategic essentialism, right? Sure, a drug may be convenient in the sense that it requires little infrastructure, but the convenience on the surface masks the infrastructure bottleneck, the prohibitive cost of these treatments–all the obstacles to making these “essential” drugs accessible. My post highlights the disconnect between the ideal of a drug as a “quick fix” and the reality that some of these so-called essentials are prohibitively costly–and there has been no highly visible move to do anything about that.
      I get the sense from your response that the reason pharmaceuticals become strongly essentialized and prioritized is because other essentials that require greater initial commitment and resources. Yet what about the high costs of these drugs?

  11. Thank you Sylvia for your post,
    Your first question is very interesting. In my opinion something is essential when one cannot live without it, and I believe that this property is innate in things. For that reason I don’t believe an essential will ever stop being an essential and I don’t believe one essential could negate another.
    I do not think that the list of essential medicines should be done away with entirely. I believe that the hope of this list is that the increased demand it creates through its “advertising” will create an economic situation where it is possible to lower the cost. Some could be skeptical of this idea, but I do believe that it is possible due to the success we have read about in lowering the cost of other drugs, namely ARV’s.
    In regards to your third question, we all know that Paul Farmer would disagree with the idea of return on investment, meaning that he wouldn’t agree with prioritizing certain medicines because of their affordability. I tend to agree with farmer that cost should never be taken into account when saving lives, and, as Farmer has demonstrated himself through Partners in Health, I believe it is possible to supply state of the art treatment to all that need it.

    1. Well, by creating a list that determines particular drugs “essential” (and assuming that there are existing medicines not on the essentials list) goes against your argument that essentiality is an innate quality. Would you argue, then, that *all* drugs are essential or just the ones that save lives? What about alleviating suffering?
      Not much has changed for global health after the introduction of ARV’s. And I don’t think this particular drug will be the ‘next ARV’, so to speak. Putting it on a list is not enough. And is it truly basic? Maybe cost should never be taken into account when it comes to saving lives, yet that has nothing to do with determining whether something is essential or not.
      Maybe it is possible for other medicines to be made more accessible, but a big part of accessibility has nothing to do with the cost of the medicine at all, but with a need for other resources. In the case of Hepatitis C–is making this expensive drug an “essential” without doing anything to lower its price going to lessen the burden of HCV on individuals and societies? And will attempting to bear the economic burden of HCV come at the cost (pun intended) of improving the conditions leading to HCV?

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