In her ethnography, Improvising Medicine, Julie Livingston presents with striking lucidity how the rising rates of cancer in Botswana, trailing the nation’s AIDS epidemic, lead to incredible suffering for an already impoverished population. The government does make great efforts to tackle the situation, having ambitiously vowed to universalize healthcare. However, given the country’s low economic status and the high prices of modern treatments, hospitals have to rely extensively on improvisation and strictly ration resources, which ultimately means that few patients have a real chance at recovery.
Unfortunately, Livingston’s harrowing accounts of disfigured limbs and toxic, nausea-inducing treatments are representative of the general state of medicine across many parts of Africa, Southeast Asia and Latin America. The numbers spell a global health crisis: 95% of HIV-infected people live in low- and middle-income countries (Biehl, “Pharmaceuticalization” 1086), while 70% of deaths from cancer happen in these same countries (World Health Organization).
Undoubtedly, it is high time we acknowledge the severity of public health issues in the developing world. Therefore, I propose that all pharmaceutical companies be obliged to waive patents for potentially life-saving drugs in low-income, epidemic-afflicted world regions. In this way, governments could mandate the local production of cheap generics for domestic use.
Ethics and Pricing Policy in the Pharmaceutical Market
Firstly, preventing poor people from accessing life-saving drugs is blatantly unethical. Expensive cancer and AIDS medications are putting an incredible strain on the tight budgets of developing countries. As a result, the latest medical innovations are only accessible to patients in rich countries, while most of the world’s diseased population finds itself in jeopardy. People are sentenced to life in misery for being born in the wrong place.
Secondly, the enormous prices of many drugs are not justified as they do not cost much to produce. It would not be difficult for developing nations to produce their own cheap generic drugs - especially given the cheap labor there - if it weren’t for restrictive international patents. This adds a monetary dimension to the ethical issue described above.
For instance, Thailand dared to issue mandatory drug licenses so that it could make its own AIDS medication. On one hand, this bold measure led to many lives being saved or improved and, on the other hand, angered the pharmaceutical industry and Western governments. The parties prosecuting the Thai government eventually subsided once the WHO intervened in support of the measure (Tantivess 334).
The Need for Drug Patents
Some would say that patents are a necessary evil. They were developed as a tool to incentivize research and reward creativity. I must agree that patents are a key driver of innovation and societal development. Still, some of us can’t help but wonder whether the high returns that pharmaceutical companies expect in exchange for their scientific developments are legitimate.
It is not necessary for companies to impose large prices on medicine in the developing world. Most expensive treatments can only be afforded by patients in developed nations anyway, so big companies would have nothing to lose from allowing developing nations to produce their own cheaper, generic versions. By employing appropriate regulations that restrict the commercialization of generics only to nations that really need them, pharmaceutical companies are guaranteed plentiful profits in rich countries.
On top of this, there are reasons to believe that much of the pharmaceutical companies’ revenue goes into insidious marketing techniques instead of the “cutting-edge research” they champion. Dr. Biehl, a reputed medical anthropologist and specialist in Brazilian AIDS policy from Princeton University, reports of medical specialists in Brazil who have been extensively lobbied by the pharmaceutical industry. On certain accounts, these doctors were instructed to prescribe more expensive drugs, paid for by the government, in cases where cheaper alternatives would have worked just as well. This ultimately leads to higher returns for big pharma, at the expense of public health (Biehl, “Pharmaceuticalization” 1109).
The Image of Big Pharma
Pharmaceutical industry executives need to start making amendments with the public. The general distrust towards the industry is not new, but activists around the world have recently started mobilizing the public to avoid buying drugs from companies with low levels of social responsibility (Hassoun). If they want to maintain their high profit margins in Western markets, allowing developing countries to produce their own cheaper versions of patented drugs would be the ultimate sign of good faith. On top of that, the move costs the industry next to nothing. After all, where there’s a will, there’s a way.
Livingston, Julie, Improvising Medicine, Duke University Press, 2012
Biehl, João Guilherme, “Pharmaceuticalization: AIDS Treatment and Global Health Politics”, Anthropological Quarterly, vol. 80, no. 4, 2007, pp. 1083-1126
Biehl, João Guilherme, “The Activist State: Global Pharmaceuticals, AIDS, and Citizenship in Brazil”, Social Text, vol. 22, no. 3, 2004, pp. 105-132
Sripen Tantivess, Gill Walt, “The role of state and non-state actors in the policy process: the contribution of policy networks to the scale-up of antiretroviral therapy in Thailand”, Health Policy and Planning, vol. 23, no. 5, 2008, pp. 328–338
Hassoun, Nicole, “How can we get pharma companies to do more for global health? Try ranking them”, The Conversation, September 20, 2016, www.theconversation.com/how-can-we-get-pharma-companies-to-do-more-for-global-health-try-ranking-them-62888
World Health Organization, “Cancer Fact Sheet”, September 12, 2018, http://www.who.int/news-room/fact-sheets/detail/cancer