E-DRUG: AstraZeneca launched new 'Patient Assistance Program' (8)
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[The Moderator will at some point close this discussion, but find the topic important as it is also relevant for donations to developing countries]
CAUTION: A VERY LONG REPLY for MR.RUSSO'S MESSAGE
I'd like to make some comments on Mr. Russo's message which I believe
a very good example of a point of view, and therefore needs to be
discussed carefully, if our moderator allow me of course. I wanted to
do this, as a forum member from "developing world". English is not my
native language, nor a language that I can express my thoughts good
enough, so thank you for your patience and tolerance in advance. And
I'd like to thank Dr.Haak for bringing this issue to the forum.
1. "Drug firms don't claim patient assistance and developing world
donation programs are enough. They are not."
Actually, they cannot. Because, as a Turkish proverb says, you cannot
run a watermill by carrying water with buckets. We, people live in
"developing world" do not need drug donations, I do kindly request
from you, please advise them as an Advisor: Do not donate! This is not
useful, and it is not working. As you said, "Many of these programs
have existed, sans fanfare, for decades. One was initiated fifty
years ago, and there are more than fifty now, plus many state and
city programs.". We had enough time, 50 years, to understood by
experience that it is not working. It just simply can not. Because the
problem is not the lack of drugs; it is a consequence, not the reason.
And if we don't deal with the reasons, then there may be two reasons
for that: 1. We are so naïve that we cannot see that our efforts are
Sysyphos-like, 2. We have our own agenda. Both, does not solve the
people's problem...
If people in your organization really wants to contribute to the
solution, then do not donate, but advocate Mr. Russo. Advocate for
lifting the barriers in front of the availability and accessibility of
rational medicines. Advocate for stopping the World Bank projects
which privatize the public health systems in "developing world", for
instance. Or, struggle against the invasion of countries by killing
more than 100,000 people directly, more than 650,000 indirectly for
overthrowing an ex-agent of US and establishing a new puppet
government for the US company interests. Or, deal with another factor
that absolutely and obviously diminish the availability and
accessibility: TRIPS and the other multilateral / international trade
agreements. I don't want to say that you are opposed to do that, I am
just trying to say this would be much more effective. This would give
us to resist one more day...
We are trying to develop, as you say Mr.Russo, we are trying to be a
place where every human being can flourish as much as her capacity,
like everybody else do all over the world. So please contribute (not
"help") us to develop, but not donate.
2. I am an academician who works on health care workers-pharmaceutical
company relationships. As you can easily guess, I know, at least
something, about the expectations, opinions, perceptions about their
work. You are absolutely right; they want to be proud with themselves,
to be able to justify the meaning of their work, and to explain it to
their children. But believe me, that kind of programs don't work Mr.
Russo, they don't feel better nor motivate. Everybody, even an
unexperienced young beginner employee, do see the trick behind this
"humanitarian" act... They feel it even before sharing with each
other. Because they are loving, caring, fearing, intelligent, ...
human beings, that's why. But I'm afraid I should add: They prefer to
pretend... Not to lose their job, of course. It is the only real
motivator, as you perfectly know. If a rep cannot fill up her quota,
she lose her job, that's it. Yes, it is immoral, they should not lie
to employers, at least business ethics (whatever it means) gurus says
that... But is it moral to try to make them believe that their
employer is doing something useful for poor people, while, by its
nature, it cannot? There are thousands of questions more, and books
about them... I am not trying to criticise or justify their act; all I
am trying to say is it is not a sincere / open game, and everybody
knows it...
3. Speaking of generics: "Many are prospering these days, selling medicines
others invented, proved and taught the professions to use". Is it a
loaded / pejorative sentence as I perceived? If it is, then I'd like
to ask that, while there is a common consensus about the production of
rational generic drugs, while it is being recommended by the org. like
WHO, especially for the "developing world", how do you make connection
between "helping to the developing world" and degrading the generic
production? And also, I'd like to ask that, why it is immoral to sell
medicines invented, proved and taught by others?
"Yet I've been unable to find any generic-drug-firm patient assistance
programs."
They don't have enough money for that kind of PR programs, that's why.
It's just a resource allocation problem.
" Surely, even at half the innovators' prices, generics remain beyond
the reach of millions of uninsured Americans."
Surely, this is a perfect indicator for the need of a health care
system organised and financed by the state regulations. What an ironic
situaiton is this! I believe that thinking about the reasons of this
phenomenon would teach us many precious lessons.
4. "I can think of one more rationale for brand-firms' patient assistance
programs: to ease the burden until Americans have the universal coverage."
If that is the case, I can easily guess the AZ's near future: It will
bankrupt in a month! Because, in order to achieve that goal, it has to
dispense ALL its drugs, to ALL patients who are in need for ALL the
time until everyone gets the universal coverage (you mean, everybody
gets all the health care they need, right?). Of course, we assume that
all AZ drugs are the best options for all patients. No? Then which
drugs? To whom? By who? Most importantly, the DURATION? Watermill...
5. "While universal access to essential medicines is beyond debate and
we must not take our eyes off that prize, neither should we discourage
steps that comfort patients, whatever motives might drive them."
There are many words which need to be defined in this sentence, like
"universal", or "essential", but let us assume that we agree on WHO
definitions. I'd like to say that I totally agree with you, we
should not discourage steps that comfort patients. But as I tried to
explain above, limited with my abilities of course, these programs are
not that kind of steps. They are tools organised to try to hide the
inequalities, and maximise the corporate profits. That is why we
should discourage this initiatives, and also, that is exactly why the
motive matters.
6. Lastly, I'd like to say something about a word Mr.Russo used in his
message. The word "silly" is not a kind word in my language, and as
far as I know, not in English too. So, by considering my limited
English, I decided to check the Webster. It has four meanings:
a. Helpless, weak
b. Rustic, plain
c. Foolish
d. Exhibiting or indicative of a lack of common sense or sound judgement
Fortunately I have checked the dictionary, it saved me from making a
rude mistake. I found out that Mr.Russo used the word "silly" in the
meaning of 4th, lack of common sense or sound judgement. Then I
re-evaluated the meaning the sentence quoted below:
"If patient assistance or donated drugs get them through the night,
it's academic and a little bit silly to second-guess how or why they
got there."
Please let me try to write this argument in classical way:
Premise 1 : Assistance programs and drug donations are useful.
Premise 2: To be academic, and to be against common sense are something bad.
Premise 3: It would be academic and against common sense, to
ask/think/critise about something useful. It is an unsound judgement.
Conclusion: Critisizing assistance programs and drug donations is
academic, against common sense, and unsound judgement.
Now I will try to analyze this argument:
- This is a valid argument.
- Premise 1, is information-based. Certainly not true.
- Premise 2 and 3, are value based. Cannot be true or false. But they
desperately need to be defined, and then justified.
- So, this argument is valid, but unsound. In other words, it is silly.
Thank you so much for sparing your time and reading.
Murat
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Murat Civaner, MD PhD
Dokuz Eylul University
School of Medicine
Dept. of Medical Ethics,
Izmir, Turkey
+90.232.412 4001
mcivaner@gmail.com