Monica Huelga
12/12/12
Anth 215: Final Paper
The Right to Health and the Pharmaceutical Industry
Government and corporations are regulating health of
individuals by not permitting the right to the necessary health care.
Pharmaceutical industries are playing with human health as a commodity and using
people as test subjects for their profit, while discounting their rights as
humans. I read an ethnographical article by Adriana Petryna from the University
of Pennsylvania, Pharmaceuticals and the
Right to Health: Reclaiming Patients and the Evidence Base of New Drugs.
This work addresses two topics covered in the Global Health Watch 3; “the
pharmaceutical industry and pharmaceutical endeavor” and “the right to health:
the concept to action.” I am going to focus on “the right to health: the
concept to action” in this report. Though the topic is straightforward, the
solution and possible consequences are much larger. The pharmaceutical industry
is a worldwide business that was created to enhance human health, but with
political obstructions, social hierarchies, and consumerism and medicalization
cultural pressures, the pharmaceutical industry is now harming the health of
mankind.
From a medical anthropology approach, the main
determinant of health must be examined: power. Power is the backbone of the
issue. Companies are essentially selling their medications like retail
merchandise. They have gained the power to persuade patients, or customers, to
purchase their product in hopes to enhance quality of life. Medications are not
being provided or available for all who need them, but ones who have reached a
certain social status to afford the prescriptions. Individual citizens are
losing power and their right to obtain medications when needed, which in turn impairs
their health status.
An individual losing their right to health is a big
concern because of the growingly neoliberal cultures. In such cultures,
individual health solely involves that person. The government and industries,
however, are imposing that duty by raising prices and limiting access of
medications needed. Medications are also causing side effects, in turn
requiring more medication to regulate symptoms, adding yet another cost. The
mega corporations are initially controlling our health, and it is becoming a
continuous cycle of needing their products. This idea of neoliberalism and
neoliberal policies was addressed in Global Health Watch and discussed in
class.
Medical anthropology reviews health, illness, and
healing among cultures. These dictate on how people approach their resources
regarding their health. The issue of the universal right to medication is that
the pharmaceutical industry is morphing perceptions of sickness, illness, and
disease to be treated with products, specifically that of their company’s. In
this case, health is a luxury. In the pharmaceutical industries’ point of view,
health is not very helpful to them. There is no improvement or treatment
needed; therefore they are not a demographic for their products. However,
clinical trials occasionally call for healthy individuals, so they may be a
profitable rarity in some cases. I recall the class discussion on “local
biology” and how the Western body is basically altered from the pharmaceutical
craze we have become enraptured in and how it is relatively uncommon for a body
to be pure and free of pharmaceuticals anymore. Health is now seen as not
needing to be treated, primarily symptom wise, regardless of past treatments.
Petryna’s topic that she examined evolved around the
trend of increased spending on research on new drugs and drug development over
the past 30 years and the implications on patients’ rights to their health care.
The high cost of conducting such trials and production increases the cost for
the consumer in turn, and reduces accessibility of medications and challenges
the ideology of the right for universal medical treatment. This article
specifically examines the global pharmaceutical industries, physicians in
specifically Poland and Brazil, and health policy makers’ relationship and the
patient’s role in the medical business, regarding accessibility and rights to
medications.
Pharmaceutical trials are in the background of the
inequalities, which sequentially impact the universal right to health. Latin
America and Eastern Europe are fairly new to the world of clinical trials.
Petryna compared these sites with offshored trials in Poland and Brazil to find
how proficiently an outsourced trial could favor a local health care system. Many
recruits are found from contract research organizations (CROs). To capture the
mindset of the CROs, one Polish doctor, a CRO member, says, “I don’t see
patients, I see data” (305). This leads to questioning of the values of these
trials and the motivation driving the production of medications, and
essentially the politics of the health care industry. Humans can’t gain equal
access to care if they aren’t even looked at as humans.
Trials have become globalized and transnational.
Brazil’s clinical trial is a large, upcoming market of studies, and they have
around 95% of their concentration in multicentered trials, which are those that
involve second and third stages that Brazil estimates they use up to 70
countries. Despite the large array of possible beneficiaries from these trials,
much of the clinical investment returns to the home country, regardless of what
data are conveyed out. To secure quality data, “patent-related agreements,
ethical guidelines, and other directives governing trial conduct” (308) are in
play for international protocol to function locally. Brazil explained that
greatly value ethical guidelines of the trials and patient confidentiality and
protection is not only commercial value to them, but also their intellectual
property.
Public health matters are questioned in this context.
A Brazilian physician explains that, in trials, he cares for the patient by
administering medication and then measuring the endpoints of the effects. That
data is then sent off for companies to use. He explains that because these
studies are essentially owned by an industry, all the physician has to do is
follow the rules and recommendations put into play. He says, “they have bought
everyone” (308).
This concept was explained as a “seeing data not
patients” model. Both physicians and patients have been given the end purpose
of providing “data integrity,” in which they are both morphed into a mold that
will succeed that goal. Industries never meet patients, which has formed a
desensitized, impersonal field of study.
In Poland specifically, who were even “considered to be too sympathetic”
(308). Such physicians were not trusted to be able to contribute useful data to
studies because they were not able to cut patients from clinical trials. Those
who viewed health in a public health perspective, a more population leveled
concern, tended to “over-enroll” patients so more could receive treatments. The
patients not chosen to receive treatment would most likely not be able to
afford the treatment for themselves. The critics of these “too sympathetic”
physicians explain, “the industry’s propriety interests in data as well as
maintaining market hold on its high-cost medicine was paramount” (309). The
research has become a project that can be separated from patient-related
factors and emotions, which creates guidelines overseeing minimal concern for
patient’s well being.
Disconnect of industry and patients and the vague borders
of research and medical care are an issue that is in the works of being
tamed. Aftermath of the research studies
is being examined, in hopes to ensure further needed treatment for the patients
involved. Clinical research and public health relations need to fundamentally
be tapered for the sake of the patients and hopefully for their benefit as
well, instead of just the industries’.
Brazil is conducing many studies to improve patient
matters. One is regarded as bioequivalence studies, which is not only testing
generic versus the brand-name drugs for lower costing quality care, but also
creating regulations of the use of “exceptional” medicines, that are those of
high-cost not typically covered by the universal heath care system. This,
however, is reducing access to essential medicines, because of the astronomical
price for the market as well. For instance, Brazil has the most advanced
HIV/AIDS program of the developing world, but with the price tag of being so
progressive and modern, citizens are suing the government in rage that they
cannot obtain their essential medications when needed. Brazil is one of 115
countries with a constitutional right to health, despite the controversies and
many stakeholders.
This ethnography stresses depth in sometimes
seemingly surface matters. For instance, it is visible that physicians are not
allowed to be “too sympathetic” and essential medications aren’t being
available at a preferred and needed rate for patients. However, there are many
social, political, and economical counterparts that come into play behind the
scenes, creating such cases. To tackle such a wide array of problems, “creative
partnerships between the public sector, academic science, and law can provide
alternatives to these trends” (325).
The Right to Health (RTH) approach, explained in
Global Health Watch, is a useful medical anthropology framework for this case.
This acknowledges many levels of the situation, local and global. There are
many politics, governmental and corporal, that are vital to recognize. The RTH
approach looks at the use of a common language for effective communication
among all the different levels, the method of empowering individuals and local
level stakeholders to account for their ideal outcome, the actual outcomes that
are experienced, and what the overall quality of care is and the speculative
ideal conditions. The approach also looks at views from vulnerable populations
who are often subject to discrimination.
The approach seems logistical, yet there are many
interpretations of what human rights are and the extent of care individuals are
entitled to. Each situation must be analyzed with this proposal in mind, but
approached contextually. Contextual aspects that must be approached are
political and economical impacts, neoliberal ideologies, public health matters,
and consequences of privatization on health services.
Social mobilization is also a result of a health
equality movement, which ties back to the discussion of power as a main
determinant of health. With more power,
accessibility to health care is far greater than of those in vulnerable, lower
income populations. In the world today, there are vast disparities of income
levels, therefore accessibility variability. A highly complex solution must be
adapted for equal health rights, mostly because it is not dealing with just the
rights to health care, but also the political and economical disparity
background.
Medical anthropological examinations of this problem
would address many perspectives. Issues are typically richer than the surface
analysis, consisting of many stakeholders and causative factors. All of those
elements then have different perceptions that give the problem a new light.
Different perceptions are important to acknowledge because it opens up angles
that aren’t appreciated in other points of view. For instance, the industry’s
perception is that the costs of drug trials are becoming higher and humans are
needed for medical knowledge and evolution. On another level, the physicians
are either just doing their job and letting the industries collect the data or
they are being affected by the lack of heart and connection to patients
required for such studies. Physician-patient relationships are not valued, but
looked at as weak and unwanted. That leads to the perception for the patients
and human subjects. The title of human “subjects” explains their value; they
are basically a commodity, or a product of information, to the industries. They
are being impacted by not receiving quality care, impaired accessibility to
necessary medications, and they are ultimately having inflicted health problems
from pharmaceutical drug trials and then not being treated for the lasting
affects. The issue addressed in the ethnography has many players with different
perception of the topic because of their environment and role they play in the
matter.
Not only do different players have different perceptions,
but also the quantity of perceptions and key players within one topic shapes
one another. Patients’ perceive an issue to be that they cannot have constant
access to medications they need. This is indeed a large issue, but it is not
necessarily out of negligence like some may inquire. Groups are trying to give
access to expensive drugs that are not typically covered by insurance or health
care coverage, which is a courteous effort, despite the opposing impacts. Not
all players are able to recognize these efforts, since it may not concern them
and much of the work is behind the scenes. Also, those now being able to have
access to the HIV/AIDS drugs, that are expensive and not typically available to
all, perceive efforts as successful.
The examples just discussed are also an example of
“situated knowledge” discussed in class and examined by Donna Haraway. This
notion confronts the context of each situation and the idea that knowledge is
contextual. This idea was demonstrated with mental health issues, but also the
important role of the culture of biomedicine. Petryna’s ethnography greatly
deals with the culture of biomedicine and the key players in the industry. The
content of the knowledge is also contextual by each stakeholder, similar to the
perceptions. For example, the physicians have the knowledge of who the test
subjects, or patients, are, whereas the industry is only obtaining the
statistical and objective data in result of the physician-patient interaction.
The patient essentially has the least range of knowledge prospectively obtained
because they are simply an object to the industry, with not much information,
or true information rather, given.
Keeping in mind the wide array of perceptions,
contextual knowledge, and stakeholders in this situation, a conceptual
perspective of the issue of patients’ right to health is slightly more complex.
I strongly believe that everyone has the right to access of means to obtain
optimal health, but it is not a simple task to grasp or manage. Industries are
distant and collective. They are very removed from the studies and programs
they are implementing, besides the profit and statistical information they
receive. Granting permission for patients to acquire medications is not as
straightforward as it seems, especially after reading this ethnographical work.
There is an entire profit-centered dogma reigning over the entire biomedical
culture that hinders the chance for change.
The medical anthropology view of analyzing the
different dimensions and approaches to the issue create a more confusing
approach to a solution. Addressing different perspectives reshapes possible
solutions by marrying the different views into a more confined approach. There
is never a solitary reason for a case, a single participant, nor a lone
solution. An anthropological approach improves solutions by accounting for
these different aspects and not assuming one interpretation. Assuming such straightforward
reasons to a problem would result in failures of implementations, compared to a
longer analysis of a problem, but more probable application.
This is an issue concerning the biomedicine culture.
The biomedicine culture, however, is global, therefore within many other
cultures. The human right to health is essential in preventing and treating
illness and many global health concerns. Health care and accessibility is the
surface issue, but there are many more causative factors that must be
acknowledged in order to create an effective, lasting solution. There are
political factors, economic limitations and barriers, and cultural values that
must be accounted for in the plan. Brazil has a constitutional right to health,
but it was evident there are still many more puzzles needing a resolution.
Medical anthropology is imperative in finding formulas for a better system of
health and people in general. The framework approaches many different aspects,
decreasing the likelihood of negative consequences. Implementing a system to
provide equal right to health for all is a long process with many dimensions
that must be valued and accepted.
Bibliography
Global Health Watch 3: An
Alternative World Health Report. London: Zed, 2011.
Petryna, Adriana. "Pharmaceuticals and the Right to Health:
Reclaiming Patients
and the Evidence Base of New
Drugs." Anthropological Quarterly 84.2 (2011): 305-29.
Web.
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