While describing his "full-pull" plan, Gogge emphasizes that it is imperative for the "reform to have a clearly limited objective: it concerns only essential medicines" (32). Such a limit is necessary because it address the worry that research will seize for medical conditions that do not have substantial impacts on GBD because pharmaceutical companies will lose their incentive to pursue cures for these less harmful diseases. Gogge emphasizes that the reform plan will be limited to drugs that are "vital to health and survival...[whereas] drugs for other medical conditions, such as hair loss, acne, and erectile dysfunction, for example, can retain under the existing monopoly patent regime with no loss in incentives or rewards" (25).
Thus, Gogge argues that the full-pull plan works so long as its market is limited to essential medicines. However, I am skeptical about how limited this plan truly is. In his discussion of ways to motivate affluent people to accept his full-pull plan, Gogge admits that the plan faces an initial difficulty: since the plan will first seek to alleviate diseases which do not commonly affect the affluent, these populations will not feel desire to assist in funding the plan because they will not be directly affected. However, Gogge contends that after some time, the diseases that commonly affect the poor will be reduced. In this case, the poor would instead begin to experience diseases that are "common among the more affluent" (35). Gogge contends that this will cause GBD patents to be developed for "more of their new essential medicines," meaning that they will research diseases such as heart disease which are more common in wealthy populations. Here, Gogge introduces a new term, "new essential medicines" without any further explanation. I believe that this term opens the door for less-essential medicines to become the target of the full-pull plan, which seems to severely inhibit the limit Gogge initially sets for essential medicines. While heart disease can be life threatening, it is hard to imagine that it is as dangerous as malaria. This ability to adjust "essential diseases" could potentially extend further into diseases which were previously excluded by Gogge's limit.
Interestingly, this term seems to be the solution to the sustainability of the full-pull plan. One could imagine a word where all of the "essential" diseases are completely eradicated. If this occured, we would have to revert back to our old incentive structure unless we had a way of creating new diseases to classify as "essential." Gogge seems to be suggesting a way to do this, but the vagueness of his approach could be problematic to those who fear the lack of limitation in the full plan.
Another quick thought: What would happen in the case of global epidemics? If companies are given incentive by impacting GBD, wouldn't they want to wait until the epidemic had spread substantially before distributing their vaccine (if they already had one developed)? In these scenarios, there may need to be certain laws forcing companies to use the vaccines that they have developed.
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ReplyDeleteNisha,
ReplyDeleteFirst, on a joking note, I think you meant Pogge not Gogge :P.
Secondly, on a more serious note I think your discussion of the limits of Pogge's "full-pull plan" is absolutely warranted. His shift from "essential medicines" to "new essential medicines" does raise questions about just how limited the plan is. I would argue that he introduces the "new essential diseases" and the discussion of things like heart disease to give the plan flexibility. If we were to set a list of essential medicines today to include those that combat AIDS, TB, and malaria, and allow zero flexibility in what is essential, the plan would serve zero purpose once those diseases have been eradicated. By allowing us to introduce new essential medicines Pogge is altering his plan to work in the future. The limited list we set now will provide incentives for companies to get on board today, and allowing the list to be adapted in the future will provide future incentive for companies to combat diseases that become more wide spread. If more people around the world live long enough to suffer from heart disease or cancer they will become essential medicines.
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ReplyDeleteNisha,
ReplyDelete(I’m posting this in two parts because my computer is being weird.)
Awesome post! I certainly see why you might be inclined to think that pharmaceutical companies would have an incentive to wait to create a vaccine until the epidemic has spread in order to get a larger financial reward by having a larger impact on GBD. (This was my first concern too.) However, I think Tierra does a great job in explaining the positional arms race mechanism to Pogge's argument here, which should keep this waiting period from occurring. In the presence of this rendition of a competitive-market solution where the winner is the company that produces the drug before other companies come up with similar dugs, the companies will try to maximize profits by engineering the drug first. After the drug has been created, they have an immediate incentive to alert the world of its existence in order to receive the possibility of receiving the global patent and "winning" the subsidized profits. And then, according to Pogge's plan, it's up to generic drug manufacturers to make these drugs at prices close to the marginal cost of creation. These companies have incentives to quickly mass produce the drugs because they receive more money for a larger quantity sold. Thus, global epidemics are actually a great example as to how Pogge's plan is supposed to incentivize pharmaceutical companies to be the "good guys" and come up with solutions bettering global health, rather than limiting the drug's scope, especially in cases of crises where more lives can be saved by increasing the number of users of the drug.
Secondly, your post made me think of a couple of questions. I am concerned as to what happens in Pogge's plan in cases where drugs have already been created but have been barred from mass production due to the TRIPS agreement. In the case of AIDS, drugs have been available for over a decade, yet because of the 20 year waiting period on mass production, millions have died. My concern here is, what incentive does the pharmaceutical company that created the AIDs vaccine and prescription drugs have to suddenly allow other companies to mass produce the drug, given that it has already been created? Yes, this company might be able to make a profit through subsidies, but it has also made an extremely large profit by holding a monopoly over the industry. It seems that Pogge must allow the original patent holder of the drug to receive funds proportional to GBD reduction even if the drugs have been on the market for over a decade, and further, these profits must exceed those the pharmaceutical company was already receiving.
This creates a further question: what would this mean for drugs like Advil vs. ibuprofen, assuming that eventually these drugs could be made "essential medicines?" (which of course they may not, but this is just an example). Should all of global profits from the existence of new markets go to the original company that engineered the drug, even if generic drugs have already been brought to market?
Additionally, I'd like to quickly comment on Pogge's distinction between "essential medicines" and other medicines because I too am concerned about where he draws the line. Campbell, I think you're exactly right to point out that "Pogge is altering his plan to work in the future" and that the immediate, obvious diseases that would be combatted by this plan are AIDS, TB, and malaria. However, I'm concerned that this list of "essential medicines" will only include drugs that can be mass produced at a low marginal cost. I know Pogge is thinking logistics here, and I understand that his plan has to start from some basis. I am also extremely intrigued by his solution for combatting diseases like AIDS, TB, and malaria. However, it seems that his plan puts more import on drugs that are less costly to mass produce. If companies could mass produce a drug to cure TB for $10/ pill or cure Ebola or a strain of cancer for $10000/ treatment (I'm making up numbers here), there will be a much lower incentive to solve the Ebola epidemic or create a treatment for the cancer strain than cure patients of TB. This seems to put a figure on human life. In the scale of global health, we obviously want to save as many lives as possible. However, is it okay to make this decision based upon the relative prices of treatment? This seems like an egregious use of utilitarian theory that I'm sure could not be morally supported. But is this what Pogge's plan requires?
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