Auschwitz: God on Trial

December 23, 2006

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(Merry Christmas)

While I haven’t read Elie Wiesel’s The Trial of God, I have read his Night. I found Night to be one of the most ghastly things I’ve ever read, due to its simple descriptions and basis in the reality of the Holocaust. In Night, Elie Wiesel describes the hanging of a child in Auschwitz. In A History of God, Karen Armstrong describes the episode thus:

It took the child half an hour to die, while the prisoners were forced to look him in the face. The same man asked again: “Where is God now?” And Wiesel heard a voice within him make this answer: “Where is He? Here He is—He is hanging here on this gallows.”

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One Life

December 8, 2006

A departure from my normal blogging fare…

Not many groups can sound this good live.

Have you come here for forgiveness?
Have you come to raise the dead?
Have you come here to play Jesus
To the lepers in your head?

We’re one but we’re not the same
We hurt each other then we do it again

You say ‘love is a temple, love a higher law’
You ask me to enter but then you make me crawl
and I can’t be holding on to what you got, when all you got is hurt

One love, One blood, One life
You got to do what you should
One life, with each other; sisters, brothers…


Patents and Patients (II)

November 25, 2006

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As an addendum to my previous post, I’ll offer these quotes from Bill Emmott’s 20:21 Vision: Twentieth Century Lessons for the Twenty-First Century. Emmott is the chief editor for The Economist. I’ll be writing a review of this book briefly, but for now, here are some quotes that jive pretty well with Stiglitz’s take on pharmaceutical patents:

“Intellectual property (that is, patent) protection for rich-world firms enables them to keep their goods expensive in developing countries while preventing local firms from competing against them.

“This is particularly problematic in the pharmaceutical business. Medicines are cheaper in the third world than in the first, but they are still costly by local standards. Pharmaceutical firms argue that they need to make profits in order to maker their research into drugs worthwhile; without patents and profits, the drugs would not exist. Perhaps more pertinent, however, is a fear that if they sell drugs very cheaply in poor countries, traders will buy them up and export them back to the rich world, undercutting the drugs firms’ profits there.

“Both these arguments are sound. Without profit, the drugs would not be invented. But there remains a question of quite how much patent protection is really needed. And, most important, there remains a question of who should pay to help make drugs cheap in the third world: the drugs firms’ shareholders or rich-world taxpayers. There is a strong moral case for the second, for the use of aid money to bridge the gap between the need for profits to repay research and the difficulty the poor face in paying the bills. This is especially important for diseases that are prevalent only or mainly in poor countries, and thus provide no profits at all in the rich world. Such aid, targeted clearly at medicines and health care, especially for scourges such as AIDS, malaria and tuberculosis, would come with risks. Over time, for instance, the drug firms might raise the prices charged to the donor governments, thus creaming off more of the aid money for themselves. The risk of smuggling back to the rich world would also persist. But it would still save millions of lives. And the moral point would be clear: it is not capitalism that is at fault in making drug prices too high and unaffordable in the third world, it is poverty.”


Patents and Patients

November 20, 2006

The right to intellectual property is fundamental to much Western innovation. If I write a book, I own that book and can sell it for what I like. If I invent a new type of automobile (or spaceship for that matter) I can profit from its sales. But should intellectual property rights be extended into all areas of creative endeavor?

 

I’ve been telling my friends for some time that much stronger government-provided incentives are necessary to bring the level of research on drugs for the poor to badly needed levels. Funding for HIV, malaria, and tuberculosis have improved in recent years, but their funding is still disproportionate to the scale of their impact. Other diseases that primarily affect the developing world don’t get as much attention from the Global Fund and the Gates Foundation, either.

 

I am always appreciative when someone well-known articulates something that I’ve been telling my friends all along, and Nobel Prize-winning economist Joseph Stiglitz (who I’ve written about before) has done just that (thanks Joe). His short piece in The New Scientist, “Award Prizes Not Patents,” offers a workable alternative to patents for drug research.

 

The absolute right to intellectual property has at times been overlooked in many of the fastest advancing fields of science. If Watson and Crick had been able to patent the structure of DNA because they first discovered it, they would have profited beyond imagination from the myriad technological advances that have stemmed from our knowledge of DNA.

 

But their ability to monopolize the use of that knowledge and ask whatever price they desired could also have stymied much additional research, and made its benefits unavailable to the poor.

 

Historically, scientists have published their research in journals and felt free to use the data and techniques originated by others (giving ample credit where it is due, of course) in the course of advancing our knowledge of the physical world. Some scientists and inventors have of course been quick to patent specific inventions which are easier to monopolize/protect.

 

But the patenting of a new drug by a pharmaceutical company makes as much sense to me as Watson and Crick patenting the shape of DNA. They were only able to discover the double helix because they stood on the shoulders of giants. And despite their lack of a patent, the rewards for research were still strong; professional respect, international fame, a place in history, career stability, and the not-insignificant monetary compensation of a Nobel Prize.

 

As Stiglitz writes, what is needed is a strongly funded program that provides large prizes for drug development based on the national and global need for new treatments. Breakthroughs in treatments for cancer, heart disease, diabetes, malaria, tuberculosis and AIDS would be rewarded prizes similar in proportion to their need, giving research companies more than enough incentive to pursue new drugs. Once developed, drugs could be distributed at cost.

 

Sound socialist to you? Well, some goods, like having drugs available to treat HIV and tuberculosis (where treatment also slows the spread of disease), are social goods that benefit entire communities, nations, and the world. Funding medical research based on the impact of disease is merely a recognition that the development of new drugs should be guided by the extent of someone’s suffering, not the depth of their wallet.

 

In addition, this particular alternative system would maintain the current level of competition among pharmaceutical companies (which is what makes the U.S. the world leader in drug development) while focusing research on drugs that would lead to the greatest public good, not the diseases for which rich people are willing to expend millions.

 

We are not isolated—disease has no respect for international boundaries—and the perverse incentives our current system gives pharmaceutical companies to research impotence and baldness have a very really cost on the poor of the world.


Quotes for Thought

October 18, 2006

Some quotes to ponder from two of my favorite doctors…

Dr. Jim Kim:

“There are more billionaires today than ever before. We are talking about wealth that we’ve never seen before. And the only time I hear talk of shrinking resources among people like us, among academics, is when we talk about things that have to do with poor people.”

“Farmer got hold of a pamphlet about how to equip labs in third world places published by the World Health Organization. It made modest recommendations. You could make do with only one sink. If it wasn’t easy to arrange for electricity, you could rely on solar power. A homemade solar-powered microscope would serve for most purposes. He threw the booklet away. The first microscope [at Partners in Health’s medical clinic in] Cange was a real one, which he stole from Harvard Medical School. ‘Redistributive justice,’ he’d later say. ‘We were just helping them not to go to hell.'”

Paul Farmer:

“God gives us humans everything we need to flourish, but he’s not the one who’s supposed to divvy up the loot. That charge was laid on us”.

“I recommend the same therapies for all humans with HIV. There is no reason to believe that physiologic responses to therapy will vary across lines of class, culture, race or nationality.”

“In an era of failed development projects, and economic policies gone bad, I sometimes feel very lucky as a physician, since my experience in Haiti has shown me that direct services are not simply a refuge of the weak and visionless, but rather a response to demands for equity and dignity.”

“Shuttling back and forth between what is possible and what is likely to occur is instructive and a lot of what shapes our sentiment.”

“I critique market-based medicine not because I haven’t seen its heights but because I’ve seen its depths.”

“For me, an area of moral clarity is: you’re in front of someone who’s suffering and you have the tools at your disposal to alleviate that suffering or even eradicate it, and you act.”


Partners in Health

October 18, 2006

Boston was amazing. I wrote a report for the group that funded my trip, and I realized it would make a decent blog post. And I got to meet Paul Farmer, who’s basically my hero/role model in many ways. I don’t think it quite qualifies as a “hero” because that implies you idolize the individual. Dr. Farmer is a figure worth looking up to because of his extraordinary work ethic, the good he’s been able to accomplish for global health, and the fact that he is an icon for like-minded individuals.

Partners in Health’s 13th Annual Thomas J. White Symposium was attended by approximately 1500 people–students, volunteers, admirers, and donors of all ages–at the Kresge Auditorium on the campus of MIT in Cambridge, MA. Partners in Health (PIH) is a non-profit organization that has grown over the past two decades to include 4000 employees in Boston, Haiti, Russia, Peru, Guatemala, Rwanda, Lesotho, and soon in Malawi, who last year provided health care to over 1 million people, including 1000 on antiretroviral treatment for HIV. PIH has had a significant impact on global health policy because of the personal dedication of its founders and the principles on which it is founded, which were expressed well by the 2000 People’s Health Assembly in Savar, Bangladesh; “The attainment of the highest possible level of health and well-being is a fundamental human right”.

The symposium, designed to summarize the past year’s activities, and to outline the policy and programmatic struggles to come, began with remarks by Ophelia Dahl, Executive Director of Partners in Health, on the last year’s expansion of PIH�s operations into Rwanda. A video was shown that highlighted the adaptation of clinical models developed in Haiti, incorporating HIV and TB treatment with community health workers and housing support, for Rwanda.

The keynote address was given by Dr. Jim Yong Kim, current head of Harvard’s Division of Social Medicine, and co-author of Women, Poverty, and AIDS. About ten years ago, Dr. Kim and Dr. Paul Farmer, cofounders of PIH, demonstrated the possibility of treating patients with HIV and Multi-drug-resistant Tuberculosis (MDR-TB) in resource-poor settings. Their research findings changed World Health Organization policy, which had previously recommended against treatment in impoverished countries. Dr. Kim recently spent three years in Geneva as the director of the World Health Organization’s AIDS program, where he pioneered a campaign to get 3 million poor patients on HIV treatment by 2005. He spoke of the triumphs and pitfalls of working within the WHO bureaucracy, of which he was previously a well-known critic. While lauding the continuing research into new cures, Dr. Kim also introduced a new program at Harvard Medical School in Global Health Effectiveness, helping to improve worldwide access to therapies currently available in high-income countries.

Dr. Paul Farmer, who has become a minor celebrity to students of international health and development after being featured in Tracy Kidder’s Mountains Beyond Mountains, spoke charismatically about the interconnection of social and economic factors with the health of the poor, and about the continued need for an equity plan to prevent and cure treatable diseases worldwide. He also praised donors like Thomas J. White, the millionaire who made PIH’s early work possible, and in whose honor the annual symposium is held.

Other presenters included Lucette Fetire, a Haitian HIV patient and advocate who told her story of how PIH first treated her, then empowered and employed her as a community health worker to help her HIV+ neighbors. Dr. Ludmilla Kashtanova, director of PIH�s Russian programs, talked of treating MDR-TB in Russian prisons, and changing the course of Russian policy to prevent further spread of the disease. Veronica Suarez Ayala and Jason Villarreal, community health workers for PIH in Peru and Boston respectively, shared stories of their patients, sometime succumbing to disease, and sometimes recovering to help others.

Personally, I found the event extremely affirming and encouraging. Meeting many likeminded undergraduate and medical students was uplifting, and being in a large crowd that affirmed a belief I strongly hold�that people should not die of treatable diseases regardless of their country of birth�only helped crystallize my goals.