Fair Trade Pharma: A Plan for More Affordable Prescription Drugs

Why do first-world ailments get cured faster than global health crises? Because Big Pharma doesn’t serve sick people, it serves rich people—let's change that.

Nicole Hassoun: I argue that human rights should give us hope and inspire us to stake our claims and help everyone live a dignified life. I think hope supports this virtue of creative resolve, which is a fundamental commitment to trying to find ways of fulfilling rights. Creative resolve is a personal as well as political virtue so that's the kind of thing that individuals can have in their own personal lives as well as in working together to bring about positive change. When each of us find obstacles to doing things that we really believe in, then I think often we need to think creatively about how can we change the problem or look at the problem differently? People might ask, 'Well, how far do you have to go with this? Aren’t we actually facing resource constraints? Aren’t there times we have to let people die?' And I was listening to this podcast of I think it was in New Orleans where they had a hospital and they had to do triage because the helicopters were coming to save everybody and it was in the flood. So there’s this nurse who had resuscitated somebody and she was pumping this oxygen bag and the doctor says to her, “Look you’re going to have to let that guy go, the helicopters just aren’t coming.” So she holds this guy in her arms while he dies. And I think that’s the point at which we should be before we give up, that creative resolve requires us to go all the way to that edge. There were 2000 people or something in that hospital who were largely unoccupied for the 24 hour or 48 or 64 hours until those helicopters came. And so creative resolve would think, how would we keep somebody pumping that oxygen bag for the next day or two? Maybe we could line people up and take turns. So I think we have to make the hope for human rights and global health and that requires each of us to think creatively about ways of helping people.

My own project is the Global Health Impact project where we attempt to evaluate pharmaceutical consequences for global health around the world and then create incentives for companies and other organizations to actually focus on extending access on essential medicines more broadly, because they can receive credit on this rating system. It’s a kind of human rights indicator that I think could make a large difference. The later parts of the book I argue that pharmaceutical companies are actually violating rights and failing to live up to their obligations when they set prices that make it difficult if not impossible for people to access essential medicines and there’s alternatives to doing that. I think there’s some more fundamental questions about how do we restructure our research and development systems to reward innovation that actually has the right kinds of consequences for global health. So rather than treating these chronic diseases of rich patients where the pharmaceutical companies can make the most money, if we can give them incentives to focus on the largest health problems around the world I think that would be absolutely fantastic. And so the idea of creating something like a fair trade label that pharmaceutical companies might love because they can make more for products that have these labels if people are willing to incentivize them to try to get that label based on having a larger health impact, that could be pretty fantastic. There’s also a large public health side to what I’m doing so, again, if we know where we’re having an impact and where were not at, say, the country level that could be really important for guiding the distribution of medicines or focusing efforts to promote positive change.

One of the world's open secrets is that we don't look after all sick people in the same way. Why does back pain in the U.S. get a treatment developed faster than fatal dysentery in Central Africa? It's not a huge riddle: research and development programs of the pharmaceutical industry treat the diseases and ailments that will turn the highest profit. To solve a problem this large and unjust, Nicole Hassoun, a residential fellow with the Hope & Optimism Project at Cornell University, is employing the virtue she terms 'creative resolve'. When obstacles get in our way, Hassoun says we need to think innovatively about how can we change the problem or look at it differently. If we can't appeal to Big Pharma's better nature, then we have to come up with more creative solutions. And Hassoun has one: fair trade pharmaceuticals. Here, she explains her idea to incentivize cheaper drugs and medical access to combat global health crises. This video was filmed as part of the Los Angeles Hope Festival, a collaboration between Big Think and Hope & Optimism.

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Yale scientists restore brain function to 32 clinically dead pigs

Researchers hope the technology will further our understanding of the brain, but lawmakers may not be ready for the ethical challenges.

Still from John Stephenson's 1999 rendition of Animal Farm.
Surprising Science
  • Researchers at the Yale School of Medicine successfully restored some functions to pig brains that had been dead for hours.
  • They hope the technology will advance our understanding of the brain, potentially developing new treatments for debilitating diseases and disorders.
  • The research raises many ethical questions and puts to the test our current understanding of death.

The image of an undead brain coming back to live again is the stuff of science fiction. Not just any science fiction, specifically B-grade sci fi. What instantly springs to mind is the black-and-white horrors of films like Fiend Without a Face. Bad acting. Plastic monstrosities. Visible strings. And a spinal cord that, for some reason, is also a tentacle?

But like any good science fiction, it's only a matter of time before some manner of it seeps into our reality. This week's Nature published the findings of researchers who managed to restore function to pigs' brains that were clinically dead. At least, what we once thought of as dead.

What's dead may never die, it seems

The researchers did not hail from House Greyjoy — "What is dead may never die" — but came largely from the Yale School of Medicine. They connected 32 pig brains to a system called BrainEx. BrainEx is an artificial perfusion system — that is, a system that takes over the functions normally regulated by the organ. The pigs had been killed four hours earlier at a U.S. Department of Agriculture slaughterhouse; their brains completely removed from the skulls.

BrainEx pumped an experiment solution into the brain that essentially mimic blood flow. It brought oxygen and nutrients to the tissues, giving brain cells the resources to begin many normal functions. The cells began consuming and metabolizing sugars. The brains' immune systems kicked in. Neuron samples could carry an electrical signal. Some brain cells even responded to drugs.

The researchers have managed to keep some brains alive for up to 36 hours, and currently do not know if BrainEx can have sustained the brains longer. "It is conceivable we are just preventing the inevitable, and the brain won't be able to recover," said Nenad Sestan, Yale neuroscientist and the lead researcher.

As a control, other brains received either a fake solution or no solution at all. None revived brain activity and deteriorated as normal.

The researchers hope the technology can enhance our ability to study the brain and its cellular functions. One of the main avenues of such studies would be brain disorders and diseases. This could point the way to developing new of treatments for the likes of brain injuries, Alzheimer's, Huntington's, and neurodegenerative conditions.

"This is an extraordinary and very promising breakthrough for neuroscience. It immediately offers a much better model for studying the human brain, which is extraordinarily important, given the vast amount of human suffering from diseases of the mind [and] brain," Nita Farahany, the bioethicists at the Duke University School of Law who wrote the study's commentary, told National Geographic.

An ethical gray matter

Before anyone gets an Island of Dr. Moreau vibe, it's worth noting that the brains did not approach neural activity anywhere near consciousness.

The BrainEx solution contained chemicals that prevented neurons from firing. To be extra cautious, the researchers also monitored the brains for any such activity and were prepared to administer an anesthetic should they have seen signs of consciousness.

Even so, the research signals a massive debate to come regarding medical ethics and our definition of death.

Most countries define death, clinically speaking, as the irreversible loss of brain or circulatory function. This definition was already at odds with some folk- and value-centric understandings, but where do we go if it becomes possible to reverse clinical death with artificial perfusion?

"This is wild," Jonathan Moreno, a bioethicist at the University of Pennsylvania, told the New York Times. "If ever there was an issue that merited big public deliberation on the ethics of science and medicine, this is one."

One possible consequence involves organ donations. Some European countries require emergency responders to use a process that preserves organs when they cannot resuscitate a person. They continue to pump blood throughout the body, but use a "thoracic aortic occlusion balloon" to prevent that blood from reaching the brain.

The system is already controversial because it raises concerns about what caused the patient's death. But what happens when brain death becomes readily reversible? Stuart Younger, a bioethicist at Case Western Reserve University, told Nature that if BrainEx were to become widely available, it could shrink the pool of eligible donors.

"There's a potential conflict here between the interests of potential donors — who might not even be donors — and people who are waiting for organs," he said.

It will be a while before such experiments go anywhere near human subjects. A more immediate ethical question relates to how such experiments harm animal subjects.

Ethical review boards evaluate research protocols and can reject any that causes undue pain, suffering, or distress. Since dead animals feel no pain, suffer no trauma, they are typically approved as subjects. But how do such boards make a judgement regarding the suffering of a "cellularly active" brain? The distress of a partially alive brain?

The dilemma is unprecedented.

Setting new boundaries

Another science fiction story that comes to mind when discussing this story is, of course, Frankenstein. As Farahany told National Geographic: "It is definitely has [sic] a good science-fiction element to it, and it is restoring cellular function where we previously thought impossible. But to have Frankenstein, you need some degree of consciousness, some 'there' there. [The researchers] did not recover any form of consciousness in this study, and it is still unclear if we ever could. But we are one step closer to that possibility."

She's right. The researchers undertook their research for the betterment of humanity, and we may one day reap some unimaginable medical benefits from it. The ethical questions, however, remain as unsettling as the stories they remind us of.

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