Health for Sale

The video below is focused on BigPharma, also known as the ten largest pharmaceutical companies in the world (AstraZeneca, Novartis, Johnson&Johnson, GlaxoSmithKline, Bristol Myers Squibb Co., Sanofi Aventis, Roche, Merck, Wyeth and Pfizer). Their combined profit exceeds that of the rest of the 490 companies on the fortune 500 combined. In 2004, they made a pre-tax profit 0f $205 billion after we the consumers spent $500 billion on their drugs. The top five killers every year are pulmonary problems, diarrhea, AIDS, Tuberculosis and Malaria, which total 15 million deaths per year. 85% of these deaths occur in the southern hemisphere, yet only 11% of world spending on pharmaceuticals goes there. There are three main problems facing medicine dispersal in the southern hemisphere. The first is that the medicines and technologies that are so desperately needed in the southern hemisphere are not being developed since the companies can make more money selling Viagra in Europe than they can selling cures to tropical diseases in South America. They invest in creating drugs that will make them the most profit and those happen to be tailored to diseases prevalent in the northern hemisphere. The following statistic says it all: Since 1975, 1500 new drugs have been invented, 13 were for tropical diseases and 4 were for Malaria, which claims 1.6 million lives each year. The second reason is that the drugs are available, but they are priced too high. For instance, AIDS drugs are available in some parts of Africa, but people that survive on less than $1 per day can not afford the expensive cocktail required to treat HIV. The third problem is, in my opinion, the most disturbing of all. There are many cases where the drugs to cure these diseases already exist, but companies have stopped manufacturing them. One point in the video sums it up perfectly: “the people who needed the medicines were there, but as consumers, as a market, they did not exist”. We have been talking all semester about people being viewed as consumers rather than human beings. Nothing proves this point more than BigPharma telling the non-consumers of the southern hemisphere that they are too inconsequential to bother saving.

Cry for AIDS Drugs

When we thing about AIDS drugs not being distributed to the poor in Africa, we tend to blame the Pharmaceutical companies (with good reason), but here is looking at the situation from a different angle. The government in South Africa that was in power up until the elections a few weeks ago would not allow generic HIV drugs to be brought in. Thabo Mbeki, the former president would not make AIDS treatment a priority and people took to the streets in protest. It takes a miracle to bring the drugs even close to the continent and then to have your own government-the people who are supposed to protect you tell you that you can not have the medicine you need even though it is available for the first time. The questions being raised reach far beyond the prohibition of HIV/AIDS drugs. The government has in place laws that prohibit even short courses of retroviral drugs to prevent the passage of HIV from mother to child during labor, despite the fact that each course is only about $5. A few provinces are defying government policy and are giving retroviral treatment to expecting mothers to try and save their children’s lives. It is bad enough that their children will be orphaned-they do not need a death sentence as well. Shelters such as the Nkosi shelter provide safe havens for women who are HIV+ and their children, but can only remain open through donations and international support. This video highlights the current struggle with AIDS in Africa, and looks at the struggle to get access to medicine from a different point of view. While BigPharma is not without fault, if the drugs are being stopped at the border, there is nothing the pharmaceutical companies can do about it.

The video cannot be embedded on other pages so there is a link to the Youtube page HERE

Future of Food

One topic that has been at the center of heated debates for much of the last decade is that of genetically modified foods. This is one topic where I can safely say that I see both sides of the issue and believe that there is no 100% right answer. The heart of the issue is the promise of GM foods versus the unknown health effects of heating tomatoes with genes for flounder in them. Before I get into the debate between whether GM foods are a cure-all or Russian roulette with our biology, I want to address an issue that clouds up this one-the issue of agribusiness and seed patenting. Companies like Monsanto have a monopoly on agriculture and no one saw it coming. They started out manufacturing herbicides and decided to join the biotech phenomenon by entering into the genetic modification of seeds. These large agribusiness companies bought up all of the smaller seed companies and put only a few kinds of seeds out on the market. They created genetically modified seeds that were resistant to one herbicide-Round Up-which happens to be the herbicide that they sell. They flood the market with their genetically modified seeds which they have patented and farmers have no choice but to buy their seeds. To complicate matters further, these companies have patents on not only the seeds they sell but subsequent generations of seeds produced from them. Therefore, it is now illegal (violating intellectual property rights) to save seeds from one harvest and dry and save them for the next, thereby ensuring a never-ending demand for seeds. Even more bizarre is that farmers can be sued for use of the seeds even if they did not plant them. As a canola farmer in Canada found out, if the seeds replicate and come to rest in your fields, either brought by wind or birds, etc., you can be sued for illegal use of the seeds. So in order, they patent the seeds, sell them for inflated prices, make you pay a technology fee, and guarantee their intellectual property rights. All of this makes you thing that GM foods and seeds are unnecessary and inflate costs for already struggling farmers. However, for the sake of evaluating only the issue of the GM foods themselves, I think we should put aside the disastrous way the seeds are distributed and focus on the technology itself. In any case, here is the introductory video which I think will be quite informative.

Genetically Modified Foods: Global Savior or Global Catastrophe

As for the issue of GM foods, there are two sides to the issue. The first side believes that GM foods are evil. They represent an ecological risk as well as a health risk and by costing more money, they further harm farmers that are barely surviving. By cutting down the variety of seeds available, they leave farmers open to agricultural catastrophes like the potato blight in Ireland in the 1800s. Yes, there were no GM potatoes back then, but Ireland was only growing a few kinds of potatoes so when the blight hit, it devastated the potato crop. The same blight hit Peru some time later and the results weren’t nearly as devastating because the variety of potatoes meant some were immune to the blight. The agricultural diversity that we enjoyed at the beginning of the 20th century is gone. 97% of the species of fruits and vegetables we had at the beginning of the century are extinct and we are working with 3%. This leaves the entire world open to insect and disease-driven catastrophes. The major health concern is that we do not know what these foods are doing to our bodies. There have been no negative reports yet, but effects could take generations to see. The following video takes the anti-GM position.

For those in favor of GM foods, I give you the following quote: “Those people who are opposed [to genetically modified foods] are not farmers. They are people who can afford food”. It may be simplistic but it gets to the heart of the issue. Genetic modifications to foods are able to make crops that are heat and cold tolerant, drought tolerant, and are resistant to infestations. Not only that, but by increasing the yield per acre, they will reduce the amount of supplies and land needed to farm and deforestation to create farmland will slow. For many poor countries, crops that are drought tolerant could be the difference between life and death for their families. Cost aside, making crops less susceptible to the elements means less crops will die in the fields each year before they can get onto the table. While the effects are still somewhat unknown, proponents of GM-foods are quick to point out that there are no negative health reports despite using GM-foods for close to twenty years now, and perhaps there never will be. Some people also think that these foods are not tested well enough before they are put in our grocery stores and sold as seeds to farmers, but the truth is that these biotech foods are tested more rigorously than conventional crops are just to make sure that they are safe for consumption. Lastly, targeting genetic changes in crops is a finer technique of the same principles that farmers have been using for centuries. The old way was to cross-pollinate two plants and hope for the best, or irradiate plants and look for a mutation. The new way is to take the guesswork and dumb luck out of the equation and make plants do what we need them to do. At one point in the video, it mentions that while it is true that not everything is known about these GM foods, it is not okay to watch while millions die and food rots in storage facilities. As Simpleton says “it is easy to be hypersensitive about new technology when you always have enough food to eat”.

This is an article published in the New York Times in 2006 that nicely wraps up the entire issue of stem cell research in Singapore and highlights some of the most important researchers who have left the United States, Japan and Western Europe for the lax restrictions on stem cells in Singapore.

2. http://www.businessweek.com/magazine/content/05_02/b3915052.htm

This is a link to an article in Business Week (Jan 2005) that talks about not just Singapore, but the rest of Asia and Australia as competing to get ahead in the Biotech industry. It also mentions some of the more groundbreaking research being done in these Asian countries and touches on the relationship between private funding in the United States and public/government funding in Asia.

3. http://www.timesonline.co.uk/tol/news/world/asia/article4568717.ece

This is an article that was run in the London Times in 2008 about the 49 infants who died in the drug trials in India, raising ethical concerns over clinical trials on patients so young and without enough properly trained staff.

4. http://www.mid-day.com/news/2009/mar/110309-illegal-clinical-trails-bang-city-news.htm

This is an article published about a month ago on a study that found evidence of illegal clinical trials in India. Three major companies (GlaxoSmithKline, AstraZeneca, and Johnson&Johnson) were performing illegal clinical trials and getting away with it since ethical review is practically nonexistent in India. The three trials were for a Breast Cancer drug, a schizophrenia drug and a drug to combat acute mania.

5. http://www.indiaresource.org/issues/globalization/2004/indianguineapigs.html

This is an extensive article put out in 2004 that explains most of the ethical problems relating to clinical trials in India. There are illegal clinical trials and problems with informed consent for patients, as well as problems with a lack of ethical and clinical review boards and problems with corruption in the approval process. It also mentions some other illegal trials that were done in other countries (Mexico, Nigeria, Russia).

6. http://www.soniashah.com/books/details.php?id=3

This is a link to Sonia Shah’s website (author of Body Hunters: Testing New Drugs on the World’s Poorest Patients). There is a summary of the book and links to other articles she has written. Her tagline: “Investigating how science and politics collide in a lopsided world”.

7. http://www.npr.org/programs/atc/features/2001/mar/010309.disease.html

This is a link to a set of radio broadcasts done on NPR about globalization and the spread of infectious diseases. As countries become closer and international travel more common, diseases are spreading to places they have never been before and new populations are being exposed to diseases they have never seen before-with lethal consequences. For instance, Dengue Fever (thought eradicated in the Western Hemisphere) sickened 100,000 in El Salvador and it probably came from Vietnam via Cuban workers that spread it through the Caribbean. You can listen to the radio broadcasts on the website.

8. http://www.youtube.com/watch?v=0Sq5SALbqC8

This is a video on YouTube about the impact of science globalization on America’s scientists. America has plenty of scientists, but the United States still imports more post-docs from overseas (Foreign post-docs have grown 52% and American post-docs have grown 9%) since wages can be lower and benefits worse. Now, the US graduates more scientists than they have jobs for, yet continue to import cheap science labor since scientific institutions have unlimited access to H1-B visas and can bring in as many foreign post-docs as they want.

9. http://www.scielo.br/scielo.php?pid=S0102-311X2002000600033&script=sci_arttext&tlng=en

“globalization has helped reduce poverty in a large number of developing countries, but it must be harnessed better to help the world’s poorest, most marginalized countries improve the lives of their citizens“. This article explores the greater disparities of health brought about by globalization and what healthy nations can begin to do about it. It also talks about AIDS, arguable the most globalized disease.

10. http://www.healthcarefinancenews.com/blog/medical-tourism-danger-our-healthcare-system-and-patients

This is an article about a new phenomenon made possible by globalization-medical tourism. Due to incredibly high costs of healthcare here in the US, many people are opting to have their procedures and surgeries done abroad, in countries that now have the capabilities due to the globalization of healthcare techniques. However, there is danger in this as well because along with the lower cost comes lower standards of care and less stringent rules about medical practices.

11. http://www.usatoday.com/news/health/2007-12-30-surrogacy_N.htm

If you thought they couldn’t think of anything else to outsource, this article makes you reconsider. The newest trend is to outsource pregnancies. Couples in the United States, Britain, Taiwan and other places, who can not get pregnant are turning to women in India to be surrogates for them. Where as a surrogate here in the US can cost tens of thousands of dollars, surrogates in India make around $4,500 and undergo all of the risk of childbirth in a country with an extraordinary high childbirth death rate.

12. http://www.scienceprogress.org/2008/04/outsourcing-science-could-pay-big-dividends-for-the-us-economy/

In this article, the author argues that the boom of scientists abroad actually helps the US by creating a competitive spirit between countries to push forward scientific research and a collaborative spirit to work together using each others techniques and resources to advance science. Apparently, distribution of scientific knowledge is not only useful for competition, but also in case one country hit’s a “roadblock” or laws prohibiting certain kinds of research [implied Bush here].

13. http://medind.nic.in/ibi/t04/i4/ibit04i4p207.pdf

This article talks about the regulatory and investigative problems with managing clinical trials in India, as well as addressing the quality of data generated from these unregulated trials.

14. http://www.mja.com.au/public/issues/180_04_160204/lee10732_fm.html

This\article talks about how health is linked to globalization and how both views of health and globalization have their merits. It talks about cognitive, temporal and spatial changes that result make up globalization. For instance, shrinking the world down and altering it spatially with new ways of travel, diseases can spread quicker. However, so can cures and containment. Outbreaks can be controlled and problems averted now that all countries are tied together in some way or another.

15. http://www.milkeninstitute.org/events/gcprogram.taf?function=detail&EvID=919&eventid=GC07

“Globalization opens the problems of the world to great scientists and allows new ways of looking at old problems that will lead to breakthroughs”, This is a link to the summary of a panel that was formed to talk about the globalization of medical research, addressing the ideal ways of handling it and what the pharmaceutical companies should do to about uncertainty in the process and pricing of the drugs.

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These are the new faces of clinical trials in poor and developing countries. For populations without healthcare living on less than two dollars a day, they have little opportunity to see doctors. Signed up for clinical trials by their parents, it is the only way to ensure they receive any care-especially if they are suffering from cancer or other types of treatable but expensive diseases. Children like these (as well as adults and the elderly) don’t have a choice. They have to be given treatment so they must accept whatever drug they have been put on. As recent events have shown, especially with the deaths of 46 babies undergoing one clinical trial in India, the patients do not always benefit from these “miracle drugs”.

“Imagine the uproar if dozens of drug-trial patients in America were to perish from deadly side effects known to the FDA. Consider the commotion if AIDS babies in Europe were to die while being administered placebos rather than potentially life-saving drugs. These scandals did happen—just elsewhere” In Sonia Shah’s book “The Body Hunters: Testing New Drugs on the World’s Poorest Patients”, she reveals the true cost of outsourcing clinical trials to India, and other developing nations where the world’s poor are systematically taken advantage of.

The people partaking in these clinical trials do not have access to health care, and often can not read so they do not fully understand the consent they are giving. Adding to the questionable ethics of these drug trials is the fact that often times, the patients do not know they are participating in the trial. They will go to the clinic for one thing and get an extra shot or drug. When asked what it is, they are given vague answers. There is a reason these trials are being done in developing countries. Lax laws and limited to nonexistent enforcement coupled with desperate and vulnerable populations provide the perfect situation for pharmaceutical companies to finish their clinical trials quickly and for 50-60% cheaper than they could in the western world. Consider the largest global Type II Diabetes clinical trial. It is taking place in 20 countries including China, India, Malaysia and Eastern Europe- all areas with large populations of poor citizens.

The push for more research overseas was given a big boost when in August of 2001, President Bush signed into law the embryonic stem cell restrictions. The bill forbid the harvesting of new embryonic stem cells, which are taken from 5-day old embryos, and restricted research to twenty or so existing embryonic stem cell lines, most of which are of poor quality. This forced researchers, many of whom were making real progress, to halt their experiments indefinitely. Many researchers, unsure when they would be able to restart their experiments, decided to take jobs overseas where restrictions are much more lax. Places like Singapore are benefiting from the restrictions in the United States, building cutting edge research parks and attracting top-level talent. However, all this economic growth centered around a set of laws in another country begs the question what will happen when the restrictions are lifted. President Obama has already vowed to end the restrictions put in place by the Bush Administration. At the same time, the same researchers that fled overseas to do their research are returning home, leaving countries new to the research world scrambling to fill the positions many think they don’t have the home-grown talent yet to fill.

Laws are beginning to be reversed, but not without controversy. Michigan recently passed a law allowing for the derivation of embryonic stem cells lines from embryos left over from In-vitro Fertilization (IVF) treatment. This is a hot topic since researchers wonder why tens of thousands of already-made embryos are remaining frozen indefinitely, though they will never be used for IVF treatment. There are also fears of the lax restrictions overseas becoming a real health issue, especially with stories like the one about a young boy with a rare genetic disease who had fetal stem cells injected into his brain in a Moscow clinic and now has micro-tumors. However, there is hope for those who think we will never resolve this particular dilemma. Researchers at the Mount Sinai Hospital in Toronto have recently used skin cells to create cells that are identical to embryonic stem cells, providing a possible way of avoiding stem cell restrictions and reestablishing stem cell research in the United States.

Another major issue is that of clinical trials. By the end of 2007, 1/3 of all of the clinical trials done by the top twenty pharmaceutical companies in the United States were done in other countries. There are many reasons for this, including obvious cost differences and the availability of large populations to quicken clinical trials. A clinical case at a top-level research clinic overseas costs one-tenth of what a second-rate research clinic in the United States would cost. There are also large populations in which to find cases for the clinical trials, many of whom are paid more than their annual income to participate in the clinical trials. This raises ethical issues about clinical trials overseas, especially since the drugs in the trial will most likely be sold primarily in America and Western Europe and the subjects they are being tested on will never receive the benefits of the drugs once they are approved.

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Embryonic stem cell research, which has been a hot topic in the United States for the last decade or so, requires stem cells to be collected from human embryos, usually those left over after In Vitro Fertilization treatments.  Wide-spread religious opposition to the use of these embryos resulted in restrictions on research and collection put in place in 2001.  Since then, countries willing to fund research with minimal oversight have been an attractive alternative.  In 2004, Singapore opened Biopolis, a two million square foot research complex and poured $600 million into start-up research, all in an attempt to capitalize on America’s lack of support for ongoing stem cell research.  The influx of some of the best minds in the world to Singapore and other countries have produced results.  China is working on a way to cure Lou Gehrig’s Disease and South Korea is making advances in spinal cord trauma therapy.  Singapore cured congenital anemia for the first time with stem cells in 2001 and is developing a way to deliver stem cells to the brain via blood rather than through risky surgery.

So what, then, are the results of this shift in research.  While these countries are attracting the top researchers in the world for now, they can not afford to keep importing scientists.  There is question as to whether they can produce their own scientists to maintain the research being done.  While Singapore continues to profit off of their new biotech industry, individual states in the United States are hoping to pass laws enabling private study of stem cells.  California was the first to pass such a law to the tune of $3 billion when Proposition 71 passed.  The pharmaceutical industry finds Singapore appealing too, with heavyweight companies such as Pfizer and Merck building factories and making $11.4 billion annually, good enough for 5% of Singapore’s economy.  The political tides in Washington are shifting as well, with the election of Barrack Obama as the president and an overwhelmingly democratic legislature, the restrictions on stem cells are bound to change in the near future-a change which is long overdue.

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Well, if you live in New York, your trash goes to Ohio, Pennsylvania, South Carolina and Virginia.  New York, and other states, have totally filled all of their landfills and are transporting their garbage out of state.  When I learned this I was a bit confused and a little worried.  I was wondering why I feel guilty about driving my car to work when the government is spending millions of dollars to haul our garbage from one place to another.  I was also worried because we are approaching a point where eventually, we will have no place to put all of our trash.  We are rapidly approaching this point, but many Americans do not give their trash another thought.  After all, a giant landfill in the Nevada desert is out-of-sight, out-of mind, right.

There are many things we can conserve, recycle and compost to try and reduce the amount of garbage we accrue, but we need to be wary of the things that will be in landfills long after we are gone.  No matter what we do, the electronics we discard are there to stay, and in lieu of a magic molecular reorganizer that turns plastic and metal into dirt, we must try to create as little electronic waste as possible.  So give it a little thought before you buy your next piece of electronic equipment and decide if it is  worth the lasting effects.