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 is a residential fellow with the Hope & Optimism Project at Cornell University and an associate professor in philosophy at Binghamton University. From 2006-2012 she was an assistant professor in philosophy at Carnegie Mellon University, affiliated with Carnegie Mellon's Program on International Relations and the University of Pittsburgh's Center for Bioethics and Health Law. In 2009-2010 she held a postdoctoral position at Stanford University and visited at the United Nation's World Institute for Development Economics Research in Helsinki. She has also been a visiting scholar at the Center for Poverty Research in Salzburg, The Franco-Swedish Program in Philosophy and Economics in Paris and the Center for Advanced Studies in Frankfurt. She has published more than fifty papers in journals like the American Philosophical Quarterly, Journal of Development Economics, The Journal of Applied Ethics, The American Journal of Bioethics, Australasian Journal of Philosophy, Public Affairs Quarterly, The European Journal of Philosophy, Environmental Ethics, the Journal of Social Philosophy, Utilitas, and Philosophy and Economics. Her first book Globalization and Global Justice: Shrinking Distance, Expanding Obligations was published with Cambridge University Press in 2012 and her manuscript Global Health Impact: Extending Access on Essential Medicines for the Poor is under contract with Oxford University Press.
Nicole Hassoun also heads the Global Health Impact project intended to extend access to medicines to the global poor (Global Health Impact). The project launched at the World Health Organization in January 2015 and has been featured on National Public Radio (New effort ranks drugmakers by impact). The Wall Street Journal (A New Index Measures Impact Pharma Has on Infectious Diseases) and Capital New York (SUNY professor indexes pharma companies' impact). The project is intended to assist policy makers in setting targets for and evaluating efforts to increase access to essential medicines. Hassoun is the author of Globalization and Global Justice: Shrinking Distance, Expanding Obligations.
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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Northwell Health is using insights from website traffic to forecast COVID-19 hospitalizations two weeks in the future.
- The machine-learning algorithm works by analyzing the online behavior of visitors to the Northwell Health website and comparing that data to future COVID-19 hospitalizations.
- The tool, which uses anonymized data, has so far predicted hospitalizations with an accuracy rate of 80 percent.
- Machine-learning tools are helping health-care professionals worldwide better constrain and treat COVID-19.
The value of forecasting<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yNTA0Njk2OC9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTYyMzM2NDQzOH0.rid9regiDaKczCCKBsu7wrHkNQ64Vz_XcOEZIzAhzgM/img.jpg?width=980" id="2bb93" class="rm-shortcode" data-rm-shortcode-id="31345afbdf2bd408fd3e9f31520c445a" data-rm-shortcode-name="rebelmouse-image" data-width="1546" data-height="1056" />
Northwell emergency departments use the dashboard to monitor in real time.
Credit: Northwell Health<p>One unique benefit of forecasting COVID-19 hospitalizations is that it allows health systems to better prepare, manage and allocate resources. For example, if the tool forecasted a surge in COVID-19 hospitalizations in two weeks, Northwell Health could begin:</p><ul><li>Making space for an influx of patients</li><li>Moving personal protective equipment to where it's most needed</li><li>Strategically allocating staff during the predicted surge</li><li>Increasing the number of tests offered to asymptomatic patients</li></ul><p>The health-care field is increasingly using machine learning. It's already helping doctors develop <a href="https://care.diabetesjournals.org/content/early/2020/06/09/dc19-1870" target="_blank">personalized care plans for diabetes patients</a>, improving cancer screening techniques, and enabling mental health professionals to better predict which patients are at <a href="https://healthitanalytics.com/news/ehr-data-fuels-accurate-predictive-analytics-for-suicide-risk" target="_blank" rel="noopener noreferrer">elevated risk of suicide</a>, to name a few applications.</p><p>Health systems around the world have already begun exploring how <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7315944/" target="_blank" rel="noopener noreferrer">machine learning can help battle the pandemic</a>, including better COVID-19 screening, diagnosis, contact tracing, and drug and vaccine development.</p><p>Cruzen said these kinds of tools represent a shift in how health systems can tackle a wide variety of problems.</p><p>"Health care has always used the past to predict the future, but not in this mathematical way," Cruzen said. "I think [Northwell Health's new predictive tool] really is a great first example of how we should be attacking a lot of things as we go forward."</p>
Making machine-learning tools openly accessible<p>Northwell Health has made its predictive tool <a href="https://github.com/northwell-health/covid-web-data-predictor" target="_blank">available for free</a> to any health system that wishes to utilize it.</p><p>"COVID is everybody's problem, and I think developing tools that can be used to help others is sort of why people go into health care," Dr. Cruzen said. "It was really consistent with our mission."</p><p>Open collaboration is something the world's governments and health systems should be striving for during the pandemic, said Michael Dowling, Northwell Health's president and CEO.</p><p>"Whenever you develop anything and somebody else gets it, they improve it and they continue to make it better," Dowling said. "As a country, we lack data. I believe very, very strongly that we should have been and should be now working with other countries, including China, including the European Union, including England and others to figure out how to develop a health surveillance system so you can anticipate way in advance when these things are going to occur."</p><p>In all, Northwell Health has treated more than 112,000 COVID patients. During the pandemic, Dowling said he's seen an outpouring of goodwill, collaboration, and sacrifice from the community and the tens of thousands of staff who work across Northwell.</p><p>"COVID has changed our perspective on everything—and not just those of us in health care, because it has disrupted everybody's life," Dowling said. "It has demonstrated the value of community, how we help one another."</p>
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- While today's computers—referred to as classical computers—continue to become more and more powerful, there is a ceiling to their advancement due to the physical limits of the materials used to make them. Quantum computing allows physicists and researchers to exponentially increase computation power, harnessing potential parallel realities to do so.
- Quantum computer chips are astoundingly small, about the size of a fingernail. Scientists have to not only build the computer itself but also the ultra-protected environment in which they operate. Total isolation is required to eliminate vibrations and other external influences on synchronized atoms; if the atoms become 'decoherent' the quantum computer cannot function.
- "You need to create a very quiet, clean, cold environment for these chips to work in," says quantum computing expert Vern Brownell. The coldest temperature possible in physics is -273.15 degrees C. The rooms required for quantum computing are -273.14 degrees C, which is 150 times colder than outer space. It is complex and mind-boggling work, but the potential for computation that harnesses the power of parallel universes is worth the chase.
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A leading British space scientist thinks there is life under the ice sheets of Europa.
- A British scientist named Professor Monica Grady recently came out in support of extraterrestrial life on Europa.
- Europa, the sixth largest moon in the solar system, may have favorable conditions for life under its miles of ice.
- The moon is one of Jupiter's 79.
Neil deGrasse Tyson wants to go ice fishing on Europa<div class="rm-shortcode" data-media_id="GLGsRX7e" data-player_id="FvQKszTI" data-rm-shortcode-id="f4790eb8f0515e036b24c4195299df28"> <div id="botr_GLGsRX7e_FvQKszTI_div" class="jwplayer-media" data-jwplayer-video-src="https://content.jwplatform.com/players/GLGsRX7e-FvQKszTI.js"> <img src="https://cdn.jwplayer.com/thumbs/GLGsRX7e-1920.jpg" class="jwplayer-media-preview" /> </div> <script src="https://content.jwplatform.com/players/GLGsRX7e-FvQKszTI.js"></script> </div>
Water Vapor Above Europa’s Surface Deteced for First Time<span style="display:block;position:relative;padding-top:56.25%;" class="rm-shortcode" data-rm-shortcode-id="9c4abc8473e1b89170cc8941beeb1f2d"><iframe type="lazy-iframe" data-runner-src="https://www.youtube.com/embed/WQ-E1lnSOzc?rel=0" width="100%" height="auto" frameborder="0" scrolling="no" style="position:absolute;top:0;left:0;width:100%;height:100%;"></iframe></span>
Study confirms the existence of a special kind of groupthink in large groups.
- Large groups of people everywhere tend to come to the same conclusions.
- In small groups, there's a much wider diversity of ideas.
- The mechanics of a large group make some ideas practically inevitable.
The grouping game<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yNTQ1NDE2Ni9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTYxMjI2MzA4OX0.RLrswIWbuEzHNqsw0F7EUrp9jPn7OulLPqCxcZT11ik/img.jpg?width=980" id="159b8" class="rm-shortcode" data-rm-shortcode-id="0feb15d2d7dde144c710c2f4f1e5350c" data-rm-shortcode-name="rebelmouse-image" data-width="2767" data-height="382" />
Some of the shapes used in the experiment
Credit: Guilbeault, et al./University of Pennsylvania<p>The researchers tested their theory with 1,480 people playing an online "Grouping Game" via Amazon's Mechanical Turk platform. The individuals were paired with another participant or made a member of a group of 6, 8, 24, or 50 people. Each pair and group were tasked with categorizing the symbols shown above, and they could see each other's answers.</p><p>The small groups came up with wildly divergent categories—the entire experiment produced nearly 5,000 category suggestions—while the larger groups came up with categorization systems that were virtually identical to each other.</p><p><a href="https://www.asc.upenn.edu/news-events/news/why-independent-cultures-think-alike-its-not-in-the-brain" target="_blank">Says Centol</a>a, "Even though we predicted it, I was nevertheless stunned to see it really happen. This result challenges many long-held ideas about culture and how it forms."</p><p>Nor was this unanimity a matter of having teamed-up like-minded individuals. "If I assign an individual to a small group," says lead author Douglas Guilbeault, "they are much more likely to arrive at a category system that is very idiosyncratic and specific to them. But if I assign that same individual to a large group, I can predict the category system that they will end up creating, regardless of whatever unique viewpoint that person happens to bring to the table."</p>
Why this happens<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yNTQ1NDE4NC9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTYyMjkzMDg0Nn0.u2hdEIgNw4drFZ2frzx0AJ_MAxIizuM98rdovQrIblk/img.jpg?width=980" id="d3444" class="rm-shortcode" data-rm-shortcode-id="5da57d66e388fad0f1c17afb09af90a7" data-rm-shortcode-name="rebelmouse-image" data-width="1440" data-height="822" />
The many categories suggested by small groups on the left, the few from large groups on the right
Credit: Guilbeault, et al./Nature Communications<p>The striking results of the experiment correspond to a <a href="https://www.nature.com/articles/s41562-019-0607-5" target="_blank">previous study</a> done by NDG that investigated tipping points for people's behavior in networks.</p><p>That study concluded that after an idea enters a discussion among a large network of people, it can gain irresistible traction by popping up again and again in enough individuals' conversations. In networks of 50 people or more, such ideas eventually reach critical mass and become a prevailing opinion.</p><p>The same phenomenon does not happen often enough within a smaller network, where fewer interactions offer an idea less of an opportunity to take hold.</p>