The Benefits and Limitations of an Essential Medicines List

From our discussions in class thus far and our current understanding of global health, accessibility to certain essential medicines would appear to be an idea that has been universally accepted for many years. The reading by Jeremy Greene, however, paints a very different picture as he argues that a list of essential medicines for global health was not successfully achieved until 1977. This marked the first time that pharmaceuticals were featured in the “public health commons” (Greene 10) and integrated into fieldwork.

One point from the reading that was particularly noteworthy was that the concept of essential medicines was originally employed by colonial powers to augment military control over other groups. Yet, it is important to note that one positive legacy of this was the enforcement of “new humanitarian standards for care” (Greene 14) to combat treatable diseases. I would argue, though, that having a standardized list of medicines deemed “basic, indispensable, and necessary for the health of a population” (Greene 10) carries both positive outcomes as well as some unintended consequences.

In lectures, we’ve discussed the issues global health workers face in reconciling their objective analyses of certain groups with their moral obligation to intervene in the lives of those they observe. To me, this parallels the dual role of the WHO in serving as a standard-bearer of pharmaceuticals as well as an active entity in responding to epidemic outbreaks of disease. Personally, I agree with the course that the WHO has taken since the 1970s by deciding to play both roles. The best example of this is the successful eradication of smallpox in 1980. Here, the combination of the WHO’s vaccination campaigns, coupled with its aggressive surveillance and prevention strategies, demonstrates that the organization’s undertaking of this dual responsibility can have positive outcomes at a population level (“The Smallpox”).

However, these strides forward come with their fair share of setbacks. For example, Greene’s articulation of “drug dumping” demonstrates the market power that pharmaceutical companies continue to wield. Firstly, this creates a culture in which outdated drugs are reserved for poorer countries and newer, more effective ones are allocated to more developed nations. This casts doubt over the relevance of the essential drugs list. If these new drugs are not widely accessible, populations may miss out on medications that are essential to maintaining health and consequently, potentially efficacious medicines may slip the public consciousness.

Furthermore, I would argue that an international pharmaceutical regulatory body like the WHO is indirectly affected by the corruption plaguing individual federal entities. For example, the FDA is often criticized for being too slow to approve certain critical medical developments and too hasty to back medications that may lack sufficient data to support their efficacy. With regard to the latter, there has been countless speculation suggesting that the FDA’s close financial ties to big pharma groups has made it more likely to approve drugs that can “cause serious harm, hospitalizations, and deaths” (“Is the FDA”). The internal corruption within these regulatory bodies has made it more difficult to ascertain these drugs’ “proven safety and efficacy via randomized, controlled trials and cost-effectiveness” (“Is the FDA”). This story is not unique to the U.S.; Chapter 9 of When People Come First describes the monopoly-like control exercised by the company Lupin over the production of certain drugs. Ecks and Harper further this point by describing the struggle to obtain certain medicines for government-sponsored programs due to the interest of profit-maximizing companies to privatize certain medications (Ecks and Harper 253). This underscores the greater conflict between moral idealism of health interventions and the economic pragmatism of drug companies.

Lastly, I think the idea of an essential drugs list takes away from the multifaceted public health approach that we’ve discussed over the course of these past few weeks. As stipulated by Max Weber, one way to understand the biologic processes of a disease is to view it in an appropriate societal, political, historical, and cultural context (Farmer et al.). In so doing, outcomes can be prescribed through a combination of biological and social processes. Furthermore, the labeling of certain medicines as “essential” detracts from the social suffering and structural violence that are responsible for many of the healthcare issues in these areas. Thus, by addressing medication accessibility without regard to these important social issues, the WHO is only remedying a small part of the problem.

 

Discussion Questions:

  1. The Greene reading introduces the reader to the concept of drug dumping yet this is only the tip of the iceberg with regard to the overall issue of updating the essential drugs list. What are some long-term negative ramifications of using less efficacious drugs to combat widespread disease incidence? What are ways to mitigate (if not solve) this issue?
  1. We’ve established that the symptomatic treatment of a disease does little to improve health outcomes and to sustain positive change. Given the many approaches that one can utilize to promote better population-level health, how “essential” is a list of essential drugs? For example, is it more important to treat infrastructural shortcomings?

 

Class Readings:

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, J. A. (2011). Making medicines essential: The emergent centrality of pharmaceuticals in global health. BioSocieties6(1), 10–33.

http://doi.org/10.1057/biosoc.2010.39

 

Outside Readings:

“The Smallpox Eradication Programme – SEP (1966-1980).” WHO. Web. 3 Nov. 2015.

http://www.who.int/features/2010/smallpox/en/

“Is the FDA Being Compromised by Pharma Payments.” Forbes. Forbes Magazine. Web. 3 Nov. 2015.

http://www.forbes.com/sites/johnlamattina/2013/08/07/is-the-fda-being-compromised-by-pharma-payments/

27 thoughts on “The Benefits and Limitations of an Essential Medicines List”

  1. I particularly agree with your argument that the essential drug list may not be essential as was once thought. With the rise of larger pharmaceutical companies and the increasing availability of medications, I can understand why the essential medicines list was once deemed necessary. Initially, it it was likely quite helpful to have a list condensing all the important medicines a developing country and its people should have access too. However, in this day, when new medicines are become more expensive and medical care is moving towards more personalized medicine, its difficult to justify why the developing countries still only have access to the “older” medicines. Additionally, treating patients with older, less efficacious drugs can create resistant strains of infectious agents, compounding the problem, and making eradication an even more challenging, and expensive task. Furthermore, I think with the rise of available medications, the opinion that drugs can fix all the health problems a developing country faces is also on the rise. While its true that a medication may rid someone of a disease, it doesn’t clean the water or put food on the table. The same health problems still exist regardless of medications, and it will take more than formulating or updating a list to solve such problems. With or without access to appropriate medications, the struggle of improving healthcare in poor, developing nations still exists.

    1. Hi Sarah,

      Thank you for your comment—it really puts the essential medicines list into context, and I agree with everything that you said. During the time it was created, the list absolutely had a specific purpose, and its success is not being disputed. Still, today, with greater acceptance of Thomas McKeown’s view of the social determinants of health and of the biosocial approach, I think community health workers and the general public have realized that medicines can only do so much to improve wellness. Without minimizing their importance, I think the ideal way to improve health in developing nations is to increase accessibility to the basic necessities you described while also beginning to fix structural inequalities and address social suffering (though this is certainly easier said than done).

      1. Hi Sachit,

        I definitely agree with you that social determinants must be addressed to truly fix health in developing countries. Looking back on this course, the one point I have taken away is that providing medication and care can only help to an extent. Making a lasting improvement in healthcare internationally will require restructuring of international relationships and social reform. In order to make health a priority, living conditions have to be humane, a society has to be just and fair, and a person has to have the ability to make a living and be happy. Compared to just passing out medications, this will take significantly more effort, and could quite possibly be an unattainable goal.

  2. Hi Sachit,

    I enjoyed your post on the essential medicine list and thought you brought up a lot of important points about its benefits and limitations. I think that the dual role of the WHO that you mentioned can be beneficial in trying to reconcile the growing power of pharmaceutical companies and the goal of responding to health needs of populations in developing countries.

    Concerning your first question, I do think that drug dumping is an increasing problem in developing countries. One long-term negative effect this can have is the lack of health improvement and a continuously high mortality and morbidity rate. Because these people are receiving bad medicine that do not follow regulations or have high enough concentrations of active ingredients, they will continue to get sick. Another unintended consequence of drug dumping and the use of low quality medication could also be the rise of resistant strains of diseases. I think that one way to mitigate this issue would be to increase security and regulations of drugs not only from the US side with the WHO and the FDA, but also from the government of countries that are receiving the drugs to make sure they are following regulations.

    As for your second question, I think that the list of essential drugs is a good concept to providing the ideology of health and medication for everyone. However, I do not think that it is the only important concept to use in promoting better population-level heath. Taking social contexts, sanitation, food, clean water, infrastructures … are very important things to consider as well, when trying promoting health. As we saw in class, medication can sometimes improve health on a population level but I think that the main way to reduce mortality and morbidity rates at this level is to promote health by improving living conditions.

    1. Hi Sachit,

      Your blog post is very informative and interesting, as you address both the benefits and harms from the implementation of the list of essential medicines. As mentioned in your reading, the role that the WHO plays is crucial to the developments and efficacy of this list of essential medicines on all parts of the population.

      To answer your first question, I believe that the use of drug dumping creates more harm than good. While the Greene reading mentions this as a way to combat widespread disease incidence, this can actually add to the spreading of diseases, as such drugs are not well regulated or proved effective. The ones who are on the receiving end of the drug-dumping are ingesting drugs that have the ability to make them more sick, with potential strains of many unintended consequences. To mitigate this issue, I think it is important for the drugs being dumped into these countries to be tested, proved effective, and heavy regulated following their implementation. It is important for the governments of the countries that are on the receiving end to carefully regulate which drugs are being used.

      Concerning your second question, I am aware of the potential consequences that may result in the list of essential drugs, but I do believe that such a list can benefit certain people. While it is more ideal to treat a long-term disease rather than to combat short-term symptoms, I think it is important to reduce the overall suffering that one endures. If certain medicines on this list can reduce the pains that one experiences, I think it is important to treat such a patient with those medicines. However, if the goal is to eliminate long-term suffering from a disease, it is economically better to avoid such a list, and rather spend money on eradicating such diseases.

      1. Hi Julianne,

        Thank you for you response! Another issue to consider with drug dumping is the possibility of infectious strains becoming drug-resistant. By promoting outdated (and possibility less effective) drugs for developing countries, pharmaceutical companies are complicit in the incidence of drug resistant cases of infectious diseases, and this worsens the condition of populations are not even equipped to combat drug-sensitive strains of a disease.

        I agree with the points you made in your last paragraph. I think its morally objectionable to withhold medications from high-needs people who can benefit from them, and if a drug reduces their suffering, then they should be entitled to its use. We should keep the McKeown hypothesis in mind, however, and realize that to achieve better health outcomes in the long-term, factors beyond the scope of one’s basic biology should be addressed at the same time as those treated by medicines.

        1. Hi Sachit,

          Thanks for your response! You bring up some great points and I agree that it will prove to be very important to be aware of infectious strains becoming drug resistant.

          In regards to the McKeown hypothesis, who do you believe is responsible of addressing health factors beyond one’s basic biology? Do you think pharmaceuticals are responsible?

          1. I think the responsibility falls to local governments and to community health workers. Still, I recognize that that’s an easy answer to a difficult question–in certain cases, governments may be the ones perpetuating structural violence and are responsible for some of the barriers to better health that certain populations face. At the same time, we’ve learned that health workers can only do so much to address these other factors and are limited in their ability to enact long-term change.

    2. Hello Claire,

      Thank you for your thoughtful answers to my questions! I agree that lifestyle improvements are as “essential” as (if not more than) an essential drugs list to ensure improvements in health at the population level. You raise an important point about drug dumping and how it can lead to drug resistance. Still, I question how effective certain governments (that are receiving these medications) would be in ensuring the security and regulations of these drugs. In economically deprived and politically unstable countries, it may not be entirely feasible to ask the government for its full cooperation in achieving this goal since the necessary mechanisms to accomplish this and prevent drug resistance may not be in place.

  3. You made a really important point regarding the accessibility of essential medicines. Naming a medicine “essential” does not do anything if medicine is not made available, especially if it is unavailable in areas where the burden of disease is the highest. I think the goal of the essential medicine list was that we would prioritize making these medicines available to everyone, but this is unrealistic without a clear approach. Another very interesting point you made is even if we can make these medicines accessible to everyone, this still may not be the most effective intervention. We have been talking about the lack of access to medicine, but ignoring McKeown’s argument that medicine does not create transitions and greater economic stability, but rather structural changes. It is unjust that there are so many who die every day from treatable diseases, but also worth considering if abandoning (or at least reducing) the emphasis on medicine and instead just tackling greater structural inequalities.

    There is not a clear answer here, but I think reducing the emphasis on medicine is a valuable point to at least consider, especially with all the problems and negative consequences that you mentioned with pharmaceutical companies. If pharmaceutical companies are limited in their freedom, or at least not expected to be the source of positive change, this will help reduce some of their power. I think that by limiting their power, giving incentive for production of essential medicine, and directing other resources towards structural changes rather than medical, long lasting change is possible.

    1. Hi Leah,

      Thanks for your insight! Given what we know from class about the McKeown hypothesis, the biosocial approach, and social suffering, it only seems logical to address a health issue on multiple levels: biological, social, and structural to name a few. As I said in response to Silvia’s comment, it is important to recognize that championing widespread medical use is important but should not result in the medicalization of social suffering (as Berger and Luckmann described). With this in mind, while an essential medicines list is important and has had successes in the past, health workers should recognize disease and other health-related outcomes for the multilayered issues that they are.

  4. Hi Sachit,

    We have been quick to criticize the shortcomings of an essential medicines list and overlook the potential positives of such a system, and I like that you were able to go in deeper detail of what the positives and negatives were, as well as what positive and negative motivations could have been. I find it interesting, but believable that this essential medicines list could have been implemented for colonial powers to have military control, and I hadn’t thought about the potential danger of that kind of motive.

    I liked that you tied the WHO into your post and discussed their role in regulating pharmaceuticals and responding to epidemics. However, with your example of the successful smallpox eradication, it makes me wonder why there has not been any other similar successes. Are there certain steps we took with smallpox that we are failing to take with diseases today? Was the approach to smallpox too extreme? If it was successful, I would imagine there to be further successes using the knowledge gained. As in other comments, I have leaned on the side of saying that an essential medicines list should not exist at all, for all of the reasons you stated, and more. I believe taking a horizontal approach attacks more of the essential issues of food, water, and shelter, but a vertical approach to smallpox has worked in the past. I wonder if there is a way to balance the two and combine what has been working in both approaches.

    1. Hi Thu,

      Thanks for your comment! I think that to understand the success of the smallpox eradication (and the apparent lack of similar eradications for other disease since then) we need to put this into context—in our lecture about colonial medicine, we learned about the unique nature of smallpox compared to other diseases like malaria. For example, part of the success in eradication was attributable to smallpox being prevented through vaccinations. On the other hand, diseases like malaria must be tackled via vector and parasite control, both of which are certainly challenging to achieve in certain developing parts of the world.

      I agree with you that there are a number of other compounding variables that need to be addressed before better health outcomes can be achieved at their full potential. While I wouldn’t call for the elimination of an essential medicines list, I agree with finding a balance between the vertical and horizontal approaches that you described.

  5. Hi Sachit! Thanks for your take on essential medicines. I found myself agreeing with most of what you said. Like you note, there is great conflict between the “moral idealism of health interventions and the economic pragmatism of drug companies.” If pharmaceutical companies were not so profit-driven, perhaps something like the essential medicines list would have space for greater utility. In the present context, the need for economic profitability does not motivate pharmaceutical companies to deliver much-needed medicines at a low cost or to engage in the development of such drugs.

    Instead, these pharmaceutical ventures are centered around dumping the cheapest and perhaps least effective drugs into populations that cannot pay for more expensive medicines. As whole, this idea of drug dumping is problematic. A high-needs populations isn’t just getting the short end of the stick–their suffering is compounded because of particular sociopolitical landscapes. Government inadequacies, a poor health system etc. all contribute to poor regulation of medicines that are “dumped” into these populations, leading to issues like substance abuse and overall mistreatment of the problem. Using less efficacious drugs also perpetrates the inequalities already rampant in such settings where there is a large discrepancy between the health of bodies who have the wealth to obtain appropriate health care, and those that don’t.

    At the end of it all, it seems that to cease drug dumping all together would be the best option. But then where to get the money for more expensive drugs or more regulation of drugs once they are in the country? If we were to try to work with the system that we already have, a closer look would reveal that the essential medicines model lacks the level of follow-up that most health care recommends. And although it may not seem intuitive that the simple act of giving out drugs needs follow-up, drug dumping makes it evident that it should be happening. So, perhaps the first step in mitigating this issue is to increase follow-up of drug delivery while also trying to incentivize pharmaceuticals to lower the prices of drugs for which high-needs populations cannot pay for.

    1. Hi Lillian,

      I appreciate your thoughts and think you articulate them very well! Drug dumping is, indeed, a very serious matter and your emphasis on the need for follow-up is an important point. In response to the second issue you discussed (companies raising the prices of drugs needed by high-needs populations), perhaps another possible solution is to pass legislation demanding companies release information to the public about how they set prices. I think this would be particularly effective as it returns power to the public in negotiations with pharmaceutical companies and places pressure on corporations to act in an ethically sound manner. Also, governments could invest more in medical research so that they can exercise more power when prices are set for approved new therapies.

  6. Sachit,
    I really enjoyed your blog post—I thought your points about the unintended consequences of the Essential Medicines list and the impacts of the practice of “drug dumping” were good ones.
    I want to focus on your point about the FDA’s regulation of pharmaceuticals in the US. It’s so easy to criticize the FDA for being a bureaucracy with potentially sketchy relationships with pharmaceutical companies, and for taking so much time to approve a drug that could otherwise be saving lives. And I agree—those are disconcerting problems. But I think it’s also important to remember that the FDA has served an important role in protecting Americans from profit-driven pharmaceutical companies. I understand that there unfortunately may be some corruption, but the FDA for the most part has kept us safe from drugs that haven’t been proven to be safe or effective. The thalidomide disaster (which Greene mentions on page 16) is a great example. In the mid-1950s, thalidomide was sold as an over-the-counter drug throughout Europe to alleviate symptoms of morning sickness in pregnant women. Then, thousands of babies were born with severe birth defects. Frances Oldham Kelsey, working as a reviewer for the FDA, refused to authorize the sale of thalidomide in the US, despite lots of pressure to do so. Thalidomide was never sold in the US, and Kelsey prevented the disaster from reaching US citizens. As I said before, I acknowledge that there may be some corruption in the FDA, but I think it’s important to remember its crucial role in keeping Americans safe from profit-hungry pharmaceutical companies.
    In regard to your second question, asking if maybe it’s more important to treat infrastructural shortcomings, I think that “everything in moderation” may be the best approach. Infrastructural access to things like clean water, clean air, and adequate nutrition are without a doubt critical to global health, but I think that being too critical of the Essential Medicines list may allow for overlooking its successes. You mention smallpox eradication as a success, and there’s also the incredibly successful global distribution of antiretrovirals to help with the AIDS epidemic! So I think maybe a combination of infrastructural improvement and access to effective medicines are both important.

    1. Hi Lindsay,

      Thank you for your comment! My discussion of corruption within the FDA was not intended to dismiss the successes of this administration. In fact, I, like you, also believe that the FDA is very important and does more good than harm. At the same time, it would be remiss of us to not recognize some of its shortcomings—I argue that if we are to believe the reports that demonstrate the FDA having close ties to large pharmaceutical companies, over-regulating certain essential medications while under-regulating some that are unsafe, and needlessly lengthening its drug approval process, then it is clear to see how these problems within the FDA can have international ramifications. That is, these flaws of the FDA can potentially limit the ability of the WHO to update its essential medicines list with newer and more efficacious medications.

  7. Sachit,

    I found your article to be a refreshing perspective on the WHO’s place in global health. As for you first question I think a huge unintended consequence of using less efficacious drugs to combat widespread disease incidence could be drug resistance. Just like when a full regimen of a drug isn’t taken, not taking enough active ingredients in each dose could cause drug resistance as the disease is not fully being combatted. I’m not entirely sure how to stop “drug dumping,” but I think holding drug companies more accountable or creating local drug companies could be an important step in mitigating this.

    One point I really liked that you made was the fact that essential medicines distract from the true social suffering and structural violence and take away from the “multifaceted public health approach.” I wonder if there would be a way to use drugs to temporarily take care of disease while more structural elements are put in place to combat these disease before they start in a person. I think that relying less on “essential medicines” and more on preventive methods might eliminate some of the difficulty in obtaining medicines that people definitely need that are not on the essential medicines list.

    1. Hi Katherine,

      I agree with you completely! Drug resistance makes the already challenging issue of treating infectious diseases all the more difficult, and promoting outdated medications could potentially accelerate the rate of drug-resistant cases for disease. As I said in response to Steven’s comment, the element of drug resistance for infectious diseases creates a number of additional problems for countries that face a double burden of disease.

      Using drugs as a way to buy time to address structural factors of health is a very novel and interesting idea. If this were possible, it is important to discuss the time horizon along which such an intervention would be carried out such that medicating the suffering of people does not lead to drug dependence.

  8. Hi Sachit,
    I enjoyed reading your post on the issues of pharmaceutical companies and essential drugs. I liked that you brought up the concept of the essential drug list masking the socio-economic problems that cause disease in the first place. Similarly I think that another problem of implementing an essential drug list is that it does not take into consideration the cultural context of the people receiving these drugs. For example, people may be introduced to pills that cure a certain illness, but in their culture it is customary to use herbal remedies not pills. The idea of essentializing Western biomedicine, again reveals the lack of cultural relativism present in international organizations like the WHO.
    In response to your second question, I think that the essential drugs list is necessary in the sense that the disease is present and in order to better an individual’s health it must be eliminated. However, I don’t think that this should come at the cost of ignoring the structural problems that need to be fixed that cause the disease in the first place. I think that in order to have health increased as much as possible both issues need to be addressed simultaneously, implementing both a vertical and a horizontal program that go hand in hand. If infrastructure is put in place of drugs, then the people that are already suffering will continue to suffer, thus the immediate problem should be addressed as well as the root of the problem.

    1. Hi Silvia,

      That’s a great point—an essential drugs list does essentialize Western biomedicine, and I would argue that this also indirectly trivializes the accepted therapies of a group of people (which just goes to show the continued innately paternalistic attitude of global health organizations). I also agree with your analysis of the need for treating health as an issue of biological and non-biological factors. Furthermore, from our readings of Berger and Luckmann’s theory of public health interventions, we know about the importance of not medicalizing social suffering and understanding it as the sum of individual structural, social, and economic problems. Health workers cannot become complacent in their belief that Western medications are the cure to all health-related issues in the world.

  9. Hello Sachit,

    Thanks for a thoughtful and informative post. I think you did a good job of addressing the unanticipated consequences that arise with the Essential Medicines list.
    I very much agree with a lot of your arguments. There is undoubtably a battle between the ideal health intervention and what is pragmatic and can be implemented with success.

    To address your second question I would say that the essential medicine list is a good starting point in thinking about the issue. While, infrastructure changes are really necessary for long term changes and there is evidence that medications don’t do much in terms of the population, these medications are definitely helping individuals. They address the problems in the individuals such as the here and now. I think a good example of this is what we discussed in class. Though the high causes of depression and anxiety are definitely rooted in social suffering and structural problems, such as high unemployment and high poverty rate, antidepressants have been shown to be extremely effective in helping people get out of bed and living their lives feeling much better. Would it really be fair to deny these people the right to feel better because we are not changing the actual living conditions that are leading to these high morbidity of mental illness.

    1. Hi Yilena,

      Thank you for your comment! I certainly was never advocating for the suspension of medications to people that need them. In my post, I was arguing that the biosocial approach as described in Chapter 2 of Reimagining Global Health calls for a multifaceted approach to recognizing and treating the causes of an illness or condition. Now, applying this to the example you mentioned, the advantages of antidepressants to people who can benefit from them are clear yet this is still (at best) only treating the symptoms of a much larger and multilayered issue.

  10. I find it canny that you bring up the fact that the concept of essential medicines was originally employed by colonial powers to augment control over other group. As you said, Pharmaceuticals are now a “market power” themselves. Part of me thinks that if we are not careful, soon pharmaceuticals will be the ones trying to augment control.

    I am left conflicted on this issue. If we are quick to promote new medicines we are basically putting more power in pharmaceutical hands. Big Pharmas would be represented in a global context. Their products may become household names and they will get to claim a somewhat “philanthropic” position. They may also eventually have the opportunity set drug prices and monopolize these countries and people. Furthermore, with the increased freedom of movement, I also think incidents of internal corruption would only get worse.

    This puts me in favor of putting older medications and generics on the essentials list because it is more difficult for such a situation (such as the one above) to happen with non-patent medications. That being said both you and the articles make good points. If a new drug works how can we keep it from people? Furthermore, it is a good opportunity to improve medical knowledge and innovation.

    In conclusion I am still trying to figure out my own disposition on this topic. I enjoyed your article because it presents both benefits and negative of each side which gave me more to think about and consider!

    1. Hi Derana,

      There are certainly two sides to this issue, each with its own convincing arguments! You make a very valid point about Big Pharma companies setting drugs prices monopolistically. In fact, just a few months ago, we observed a Big Pharama power play in the case of the drug Daraprim (here’s a recent update about the drug’s price hike– http://www.chicagotribune.com/business/ct-turing-doubles-down-1205-biz-20151204-story.html). With this in mind, though, while promoting certain new drugs can pose the risks you described, I still believe that this is necessary to ensure the advancement of drug therapies in medicine. Perhaps to combat this issue, regulatory agencies can work to enforce new legislations that disbands pharmaceutical market power and bans predatory pricing.

  11. Thank you for you post Sachit,

    To answer your first question the one primary ramification of using less efficacious drugs that I can think of is creating new drug resistant strains of the same disease. By not wiping out the disease in the initial treatment, a secondary more powerful would be required to treat the individual and all the others infected by this new strain. The way to fix this would be to update the essential drug list and have all affected on a course of the most effective medicine to avoid creating new strains or having to treat in a second wave.
    In regards to your second question, I have to agree with you that it is vital to treat the root of the problem to create long lasting health benefits. With that said, I also believe that on a personal level these drugs can have a very really and meaningful impact on one’s quality of life. For this reason, I would not say that one is more essential than the other, I would just hope that we wouldn’t have to pick between the two.

    1. Hi Steven,

      Thank you for your comment! You bring up a very important point—I absolutely agree that continuing to promote outdated medications exacerbates the issue of drug-resistance for certain infectious diseases. To relate this with some themes we’ve discussed in class, drug-resistant cases of diseases might even pose more harm to some of the already vulnerable populations of the world that face a double burden of disease.

      I agree that drugs are extremely important to improve the quality of life of people that need them—I certainly didn’t mean to imply otherwise. My only suggestion would be that we not medicalize all issues that can also be viewed from a biosocial perspective.

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