"Access to Medicine: Moral Imperative and A New Consciousness” - PART V

Jenik Radon
Adjunct Professor of International and Public Affairs, Columbia School of International and Public Affairs
Alongside doctors, nurses, and other healthcare professionals, pharmaceutical companies are responsible for the wellbeing and the lives of millions of people around the world. But as pharmaceutical research has become more complex, abstract, and even separated from the medical profession, there is a risk that the industry is losing sight of its mission, helping people lead healthier lives.

Maree Newson,Research Associate, Vale Columbia Center for Sustainable International Investment, Columbia University

Earlier in this series of articles, we explored the human right to health, the diseases that trigger that right, and the types of medicines that should be considered “essential”. In the previous issue, we discussed the practicalities of funding access to those essential medicines, and the pharmaceutical industry’s role in distributing those medicines. We raised the example of Gilead, a pharma company which has assured the availability of its HIV/ AIDS medication at low cost in countries where it is most needed.

Consciousness Raising, A Further Sine Qua Non
Examples of access programs like Gilead’s are also useful because they change the way the industry is viewed and views itself, and, perhaps, the standard to which the industry holds itself. This consciousness raising is itself important.

Inherent in a moral imperative is a continuous search for an answer, namely how to live it, and with respect to access to medicine there are still no generally accepted answers, certainly none that transcend borders. Governments, pharma industry, the insurance companies and NGOs cannot agree on how to implement such access, certainly not internationally. In order to advance access to medicine, the awareness that pharma touches people and impacts them intimately needs to be heightened for all those working in the pharma industry, whether scientists or accountants or distributors. And the way forward is for all who work in this industry to be conscious that the industry is special, that in its essence is an extension of doctoring, and that it has a critical mission, namely satisfying health needs.

Jenik Radon, an author of this article, was Executor/Trustee of a German pharmaceutical company, Vetter Pharma Fertigung GmbH from 1999-2007 and continues to serve as independent legal counsel for the Vetter Group in Germany. The Vetter company is a major producer of prefilled injectable systems for the pharma industry. To convey its health mission to its staff, Vetter, among other things, had pictures of patients hung on many walls in order to remind all of its employees that it was not simply producing every-day consumer goods but special goods. Rather, the Vetter company sought to underscore that its business was special – filling injectables with drugs for patients around the world – and this demanded a never ending focus and dedication to quality even in the performance of the most tedious, but vital, tasks such as visual product inspections. Moreover, the Vetter mission statement was revised to note that its ultimate customers were its patients, and not just the next buyer in the chain of commerce. These simple actions helped to give meaning to all aspects of the company’s and its employees’ work, whether analytical, production or administrative. The question is how such consciousness can be extended and expanded.

Similarly, consciousness can be raised in other ways. For example, the adoption of a Hippocratic Oath, a mission statement, for the pharma industry can serve as a similar reminder and incentive. Certain professions related to health have long acknowledged a special responsibility. For thousands of years, doctors have recognised their unique duty, as enshrined in the ancient Hippocratic Oath, which is still today taken by newly admitted doctors. At the time of Hippocrates, and until relatively recently, the role of a doctor also incorporated the preparation of medicinal remedies. The Oath recognised the unique position of trust, knowledge and power that doctors enjoyed in society. Yet, as economic, social and legal divisions have emerged between doctors, pharmacists, and pharmaceutical chemists, the obligations of the Oath have remained only with doctors. The Oath has never been sworn by people in the pharma business who make the medicines that doctors need to administer. A start, however, has been made in pharmacology schools in the United States, which have begun to have their graduates adopt a Code of Ethics. But pharmacologists are only a small minority of those working in the pharma industry.

Yet pharma corporations have not been ignorant of their duties to society as a whole. In 1943, the chairman of Johnson & Johnson prepared the company’s “Credo”, a vision statement that begins: “We believe our first responsibility is to the doctors, nurses and patients, to mothers and fathers and all others who use our products and services. In meeting their needs everything we do must be of high quality.” Following this, the Credo cites responsibilities to the corporation’s employees, the communities in which they live and work and to the world community as well. Then, the “final responsibility” is to the corporation’s stockholders: “When we operate according to these principles, the stockholders should realise a fair return”. The Johnson & Johnson Credo of 1943 still needs universal application.

One of the authors argues that a Hippocratic Oath should also apply to the executives and management of, and all others working within, pharma companies. Such an Oath will raise everyday awareness of the industry’s mission and ensure that all within the industry become voices to be heard on how this mission can be fulfilled and lived, which is important as long as the answer remains elusive. A start is that author’s adaptation for the pharma industry of the modernised Hippocratic Oath:

  • I swear to fulfill this covenant on my behalf and that of my fellow employees, to the best of my ability and capability, and I will have the pharmaceutical company in which I work dedicate itself to the fulfillment of this covenant.
  • I recognise and respect the hard-won scientific gains of physicians, nurses, pharmacists, scientists and other medical workers in whose steps I also walk.
  • I recognise that I work for a company whose products are special as they have the power to relieve pain or discomfort or heal sicknesses in human beings.
  • I will remember that the medicines my company produces treat a sick human being, who may well be my own mother, father, child, family member or friend, whose illness also affects a person’s family, economic stability and emotional health.
  • I recognise that the end consumer and customer of my company’s medicines are sick human beings.
  • I will remember that all persons are equal, wherever in the world, with an equal right to life and good health.
  • I will work to have the medicines that my company produces made accessible to all so that they can cure illness and disease in all people wherever they may reside;
  • I will remember that I am a member of society, with special responsibility to all my fellow human beings, especially the sick, as my company’s medicines can improve and even restore their health.
  • If I do not violate this oath, may I enjoy life, be respected while I live and remembered with affection thereafter. May I always act so as to preserve the finest traditions of those who administer and provide medicine.
A pharma Oath might be one step toward the realisation of the human rights imperative embedded in Article 12 of the International Covenant on Economic, Social and Cultural Rights. The access to medicine discussion is clearly part of a larger ethical and pragmatic debate about provision of health care that has no easy or immediate answers, let alone an inexpensive answer. But raising the consciousness of all those involved in the pharma industry about their important, critical and special, if not unique, role will invigorate the way forward in finding mutually acceptable societal solutions to the provision of international drug access to medicine to the poorer nations as well as all others who need it, even if they cannot afford it.

Twelve years after the start of the PMA case, access to medicine is still an idea without clear parameters. While the PMA case highlighted the need for international access to medicine, especially with respect to life-threatening emergencies such as AIDS, the concept has not significantly advanced in practice since the settlement of that case. From a purely utilitarian perspective, as healthy nations are better and more stable economic and political partners, it may be in the self-interest of developed nations to improve access to medicine for chronic illnesses in the world’s poorer and developing nations, which has become another goal of the access to medicine “campaign.” From a utilitarian point of view, healthier nations have better consumers.

Even if the goals of “access to medicine” are clearly defined, governments will nevertheless be unable to reach those goals without the involvement of private industry, if for no other reason than the fact that the industry is the motor of drug development. Pharmaceutical companies may well opt to provide broader access to medicine as they have come to realise that growth in the pharma industry depends on the emerging markets and its significant, albeit poorer, population, and that the pharma industry needs to address the societal and political concerns of that market in order to succeed.

The pharma industry needs a social license, social acceptance, in order to succeed in that market. Accordingly, the industry can, for example, adopt a different business model and create sustainable profit through strategically tiered pricing. These companies may also develop access programs because they feel it is socially responsible and because they have come to recognise their unique responsibility as providers of health products to the end users of their products, the patients. Highlighting and living that responsibility will be critical in making access to medicine a reality and securing a social license to operate in the emerging market.

Recognising the moral imperative to deliver drugs to sick people and creating sustainable and pragmatic incentives to make that financially feasible are both essential parts of the effort to make the world healthier. A pharma Hippocratic Oath would be a welcome step to make the vision of a healthy world a reality!