All posts by Sachit Singal

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 Firstly, this creates a culture in which outdated drugs are reserved for poorer countries and newer, more effective ones are allocated to more developed nations.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/