Throughout this semester we have discussed many issues pertaining to access to medicine. Most of our discussions have centered on the removal of negative restrictions that limit an individual or groups access to necessary medications.
New York State implemented an assisted outpatient treatment, involuntary treatment, law after two people were assaulted in the subway system by untreated men. The law is known as Kendra’s Law, named after one of the victims. DJ Jaffe writes for Forbes.com:
Studies over 10 years have shown Kendra’s Law helps the seriously mentally ill by reducing homelessness (74%); suicide attempts (55%) and substance abuse (48%); keeps the public safer by reducing physical harm to others (47%) and property destruction (43%); and saves money by reducing hospitalization (77%); arrests (83%) and incarceration (87%). Surprisingly, 81 percent of those ordered into treatment said AOT helped them get and stay well.
Forced medication seems to benefit the individuals who receive the treatment. Does the fact that these people do not seek the initial treatment themselves constitute a violation of their rights? Or is forced treatment a mechanism that seeks to protect the human rights of the greater portion of society? Jaffee argues that the New York State Office of Mental Health does not go far enough, and does not extend treatment to a large enough population. I am not sure how I feel about this. Jaffe is founder of Mental Illness Policy Org, a pro-treatment organization. The organizations overwhelming website has vast amounts of information in support of forced medication.
Implied within Jaffe’s argument is mental health patients are a violent threat to society, and therefore should be forced to take medication. I do acknowledge that there have been violent acts committed by patient who may have been well served by medication, but these acts represent a minority of cases.
This week South Korea is chemically castrating a repeat sex offended. This is the first time the judiciary of the nation is implementing this punishment after its allowance by a 2010 law. The offender is pending release from prison, conditional upon regular injections to decrease his level of testosterone. The injections deal with his deviance on a hormonal level, though they do not serve to socially rehabilitate his condition.
In discussing the rights of the patient who receive involuntary treatment- Is it possible that these procedures are a violation of individual civil rights, while concurrently serving to protect the human rights of a larger society?
From the perspective of development health is correlated with increased life expectancy, this is one of the measures that is used to gauge the overall health state of a nation.
David Jolly of the NY Times writes: “Push for the Right to Die Grows in the Netherlands” an article that highlights an organization, Right to Die-NL, that advocates for medically assisted euthanasia. Assisted suicide has been legal in the Netherlands since 2002, but may only be used for situations of “hopeless and unbearable suffering”.
Right to Die-NL and another organization, Out of Free Will, are calling for the creation of law that would allow any Dutch citizen over the age of 70 to utilize assisted suicide. Out of Free Will’s response to the choice of 70:
The group admits the age of 70 was a somewhat arbitrary cut-off point. “Whether it should be 65 or 90 is a good question. We think that once someone has reached old age, he has proved his ability to live. He can then chose to leave this life in a procedural, medically-supervised manner
Should assisted suicide be considered medicine? If we are ethically “ok” with allowing the terminally ill to utilize euthanasia to end life on their own terms, are we equally “ok” allowing someone over the age of 70 to do so? The NY Times article does point to a need for an increased level of palliative care for the terminally ill. Has the developed world reached a plateau of life expectancy, where citizens over the age of 70 will now choose to end life of their own free will?
President Obama has sponsored legislation to protect the rights of women in the United States, this law is being contested by some religious organizations and conservative politicians. The law that is being debated requires employers to cover the cost of contraception. In class we have touched upon the fact that family planning increases the earning potential and political autonomy of women in developing nations. Is the situation different for women in the US?
According to an article by Nick Baumann “Most of Obama’s ‘Controversial’ Birth Control Rule Was Law During Bush Years.” US Senator John McCain has recently changed his position concerning womens right to birth control. According to the Senator “I think we ought to respect the right of women to make choices in their lives.” This is a novel idea. While I suspect that McCain may have some implicit political agenda in his change of stance, I see it as a move in the right direction. The truth about contraception and womens bodies is frequently concealed behind political agendas, as highlighted in a Huffington Post article by Kay Hall.
Opposition to the legislation comes from organizations that seek to “Restore Religious Freedom in America.” I do not personally understand how freedom is restored by limiting womens rights to make decisions concerning their own bodies. From my perspective the bill does not endanger religious freedom in any way, someone still has the option to choose not to use contraception. The bill does protect the rights of those who wish to use contraception.
Doctors Without Borders (MSF) recently released a call for increased funds to combat HIV and TB in Myanmar. The population of the country is just under 48 million people, MSF reports that 120,000 people are living with HIV and 300,000 are living with TB. That works out to 1:400 people living with HIV and 1:160 with TB, of particular danger and relevance to this report are those living with co-infections. The report states “20% of people living with TB in Myanmar are co-infected with HIV/AIDS.” This 20% of people living with TB represents 50% of those living with HIV, from my view this paints a more dire picture. Is HIV a risk factor for TB? or is TB a risk factor for HIV? or is there some other factor that compounds the risk for both? The average per capita income is reported as $379.60 by the United Nations. We are not afraid of poverty, but we sure are afraid of Multi-Drug Resistant Tuberculosis. What comes first, HIV or TB? What comes first, poverty of infectious disease?
How do we make sense of all this data? This is a link to an animation of the relationship between health and wealth: gapminder
There are numerous TED Talks by Hans Rosling, a Swedish public health professor who developed the gapminder program, these talks are interesting and informative. Rosling uses his software to create visual representation of data, which allow analysis of trends over time. This is an interesting, 20 minute, talk that he gave at the US State Department where he calls for a re-framing of the term “developing world”: Hans Rosling TED Talk. Part of the argument posed by Rosling is that there is a huge degree of disparity within geographical regions, and within nations themselves, and also similarities between “developing” and “developed” nations.
The term “Developing Countries” might have made sense once.
Today it’s impossible to make a clear distinction between “developing” and “developed” countries.
The economics of supply and demand have allowed drug companies to reap exorbitant profit from the market, but what are the effects when the supply does not meet the demand? The United States is currently wheeling from a shortage of two drugs used to combat cancer, this shortage has prompted the FDA to seek drugs from foreign markets, such as India. The two drugs are Doxil and methotrexate, which is known by the trade names Rheumatrex and Trexall. Pharmaceutical companies have a market interest in providing their products to consumers. After the introduction of a product, should companies be mandated to ensure a consistent supply chain? As patients/consumers what assurance do we have that life saving drugs will be available if we need them? In some way I can see situations such as this manifesting a loosening of international trade agreements. If India did not have a readily available supply of a drug similar to Doxil this would have undoubtedly affected the lives of a larger number of people. The intellectual property rights of drug developers are protected through trade agreements, what is the impact of these protections in critical shortage situations? The loosening of patent restrictions may improve the health of consumers by ensuring access to needed drugs, while keeping costs lower.