Over the past couple of months I’ve heard arguments against private institutions being forced to cover birth control pills for their employees. Perhaps I’m biased as a female myself and believing that is every woman right to have the choice and access to all forms of contraception including birth control pills. Most legal arguments presented simply stated that the government has no say in what type of health care private institutions provide since they are not receiving any government funding. However I was still appalled to hear the language and stereotypes which fueled some of the other arguments.

One such argument which I found particularly offensive is that these institution should be made to pay for birth control, so that women can be as promiscuous as they please. I found this to be shocking that such a stereotype was still so heavily present. A man carrying a condom is considered smart, however a woman on birth control pills is considered a “slut”? Do woman not have the right to protect themselves and have ownership over their bodies?

Another argument made was since there are still cheaper alternatives to birth control such as condoms, it wasn’t essential for women to have birth control pills. First I believe that this places all of the responsibility on men and women should take equal responsibility when it comes to contraception. More importantly for women birth control pills are not only used for contraceptive proposes, but also for dealing with serve cramps, hormone imbalances, and acne. This brings up the question of are birth control pills an essential medication? I know many women who suffer from serve cramps and would considered it comparable to torture. They often have to miss work or school due to their symptoms. Wouldn’t it then be an essential medicine for those who are suffering?

Finally an argument was made that if women want or need birth control medication they should just purchase it themselves and not force their employer to pay for it. This was fueled by the belief that since there are so many birth control pills currently on the market, that it must be affordable. However birth control medication is different for everyone women, since each of our bodies are different. The generic or cheaper brands may not compatible with all women and with some birth control pills costing as much a 60 dollars a month, it is not within everyone reach. So should those women who can’t afford it be denied access to proper birth control medication?

Today this argument is back on the table with the many recent lawsuits of the Catholic groups against the Obama administration’s birth control mandate. The addition of religion to the argument brings an entirely new discussion of rights. Now there is the addition of the right to freedom of religion. Does one right trump another right?

I do not believe that one right takes precedence over another. However I’m concerned with the rights of students or employees of institutions such as the University of Notre Dame which has also recently  filed lawsuit against this mandate, though they did so hesitantly. It is understandable that the government has no right to interfere with the church itself. But does that mean the church as the right to force their beliefs and practices on individuals which attend or work for educational institutions such as Notre Dame? In the past there has also been the case of Georgetown Law School in which a student sued for not having have access to contraceptive coverage. Although I highly doubt a student would ever choose not attend an esteemed educational institution due to lack of contraceptive coverage. But should there even have to be choice between right to an education and right to access of medicine?

Read more on current legal battle:
http://www.washingtonpost.com/national/on-faith/analysis-catholic-bishops-divided-in-legal-battle-against-obama-birth-control-mandate/2012/05/23/gJQAvb0KlU_story.html

Many drugs being used to treat Malaria in disease ridden areas could be substitutes, or could even be fake.

The Lancet Infectious Disease Journal reported that up to 42% of the Malaria drugs used in Southeast Asia or Sub-Saharan Africa could be ineffective, being either counterfeit medication, a substitute medication or just a placebo.

The governments of the countries where these ineffective drugs were discovered are being urged to regulate drug production more strictly.

People along the borders of Thailand and Myanmar have been found to carry a Malarial parasite that is immune to the best anti-Malarial drugs available, called artemisinin combination therapy, or ACT.  In Cambodia, drug resistant Malarial parasites were also discovered.  These new cases showing up along the borders of Thailand and Myanmar are different in the fact that it is a different parasite these patients are carrying.

“Anti-malarial control efforts are vitally dependent on artemisinin combination treatments,” says  Anne-Catrin Uhlemann and David Fidock of Columbia University.  “Should these regimens fail, no other drugs are ready for deployment, and drug development efforts are not expected to yield new antimalarials until the end of this decade.”

I spent last weekend at school participating in a Southern African simulation game. Two sections of Southern African politics classes were divided into a dozen groups: African National Congress (ANC govt), common people, trade union, businesses, United States, etc. The goal of the game was for each team to advance its position in South Africa and for students to experience the complexities of working within an international economy and making decisions that are beneficial for both their individual team’s interests as well as for the people of the region.

As a member of the white business team, I had the difficult task of creating policies that would not only financially advance my team but also improve public opinion. The idea that rich white people hold a special responsibility to aid the less privileged is a global one, and in order for our team to be embraced by the common people, we had to create an image of caring and generosity.

Between the common people group and their Occupy South Africa movement and the government group’s general inaction, my team decided to create the Caring Corp foundation which would allocate charitable funds to various causes including education grants, building hospitals, tackling HIV/AIDS, etc.

One of the most surprising realizations throughout the game was the sheer neglect of all health-related concerns. South Africa has the one of the worst HIV/AIDS epidemics in the world, with 5.6 million infected in 2009. And yet the ANC ignored the problem and said that they had more urgent concerns within the context of the game. South Africa has a history of AIDS denial– former President Thabo Mbeki claimed that the cause of AIDS was not a virus, but poverty; this led to hundreds of thousands of preventable deaths.

Participating in this simulation game, I began to think about the right to health, and the parties responsible for maintaining that right for all people. If health is indeed a human right, is it then the government’s obligation to protect this right by providing access to healthcare? In our game, which accurately mirrored reality, the government was unresponsive to concerns over the growing AIDS problem and other access to health matters that affect the common people. In our attempt to improve our image within society, the white businesses teamed up to give back to the community, but in reality, how much can a few billionaires (and their billions) really do? Is it our responsibility to provide some short term relief (I say short term here because the nature of our charity depends upon rich peoples’ kindness, which like other kindnesses, is a temporary and fleeting resource).

This game taught me that health should not be a charitable endeavor in which the many poor must rely on the few rich for support. It also taught me that governments are constantly bombarded with urgent issues that need attention–and chronic lack of access to health take a backseat to economic and foreign affairs.

This week, the Washington Post reports that, even in some countries with lesser standards of living than the US, access to medical care surpasses ours.  In Thailand, only 1% of the population lacks health insurance.  The Mexican government created a safety net to insure 50 million people who are not covered by existing plans.

And in former communist countries, the urge to capitalize medical treatment that followed the fall of the Soviet system has been replaced by a social-service sensibility:

Two decades ago, many former communist countries in Eastern Europe and elsewhere dismantled their universal health-care systems amid a drive to set up free-market economies. But popular demand for insurance protection has fueled an effort in nearly all of these countries to rebuild their systems. Similar pressure is coming from the citizens of fast-growing nations in Asia and Latin America, where rising living standards have raised expectations for better services.

In the US, about 50 million people have no health insurance, roughly 16% of the population.  This percentage rises for the poor:  a 2009 study by the Kaiser Family Foundation reported that 45% of low-income Americans under the age of 65 have no health insurance.   The Affordable Care Act of 2010 will reduce these numbers — but we won’t know until next month whether the Supreme Court will find some or all of it unconstitutional.

Even if the ACA stands, it doesn’t abolish for-profit insurance companies (or constrain their power much), and its direct effects on the costs of medical diagnosis and treatment remain to be seen — so while more Americans will have insurance, some will continue to be unable to pay for some of their care.

Big question: why is the US different from Thailand, Mexico, or China?  What makes the idea of universal access to medical treatment so complicated for us when it seems to be increasingly simple for countries that have lesser GDPs?

Throughout various discussions in class about life-extending medications and the debate over the value of life-improving medications vs. life extending medications, I have come to realize that our society often tends to associate a longer life with better health. After all, the graphs we observed at the beginning of the year measured a country’s health by the average life span of its citizens.

http://ucatlas.ucsc.edu/spend.php

Countries that have very low life expectancies (under 70) clearly have significant barriers to proper healthcare and medicine, since with today’s technologies and advanced medications there are known ways to fight disease and issues that lead to early death.

But when considering life expectancy in developed countries with advanced medicine, I think it is important to discuss whether extending someone’s life when they are very sick is always the best option. Currently, it is legal for patients to sign a document that establishes whether they want to continue life-sustaining treatments such as respirators or artificial nutrition when they are no longer able to communicate. However, this becomes a lot more complex in situations where the patient has not signed their decision in writing, as the family must make this decision and there is not always an agreement on what is best for the patient.

There are other cases in which patients are not in a complete vegetative state, and so there is no legal precedent for that patient to request to be let go, but extending a patients’ life might indeed be leading to more pain and suffering than if they were allowed to die. Is it morally wrong for a patient to ask a doctor to hasten their death if it will alleviate physical suffering or psychological degradation?

Since wanting to die or live under certain conditions is a very personal choice, it is difficult to establish laws on this issue. Furthermore, different family members might disagree on what is best for the health of their loved ones, and in these cases, who should have the right to decide whether one should continue to live?

Most will agree that life and health are human rights, but the questions of what quality of life and standard of health vary across individuals and across the globe. When reading about this topic, I came across this website that brings up a lot of fundamental questions on this issue that relate to human rights:

Who decides when pain or suffering is “unbearable” enough to prefer death?

Is alleviating pain to a terminally ill patient through euthanasia considered murder? Or is the opposite, forcing them to live in suffering, considered torture?

Who decides whether a person who is suffering from extreme dementia is content or suffering?

If people do have a right to end their lives, should this only be due to physical pain or can mental suffering such as agony from inability to function properly also a valid enough reason?

Which family members should have more decision power in whether a loved one’s life should be artificially sustained?

These issues are further complicated by the fact that different cultures and religions have completely different views on life, death, medicine, and individual vs. family rights. Although this is primarily a moral question, this issue plays a fundamental role in healthcare costs and technology and medicine development.

As the semester draws to an end, I find myself overwhelmed by the surplus of new ideas, realizations, and data I have acquired by taking this class.  In many regards, I find myself asking more questions than I had when we began: What are Human Rights?  Are Human Rights universal? Is healthcare or health a Human Right? 

There is another question I am struggling with, however… is healthcare a right or a responsibility? 

 Is it a fundamental right, one we are born with and one which cannot be denied, or is it something much more unstable and shifting?  We have bumped up against this question time and again.   

 I would like to argue, then, that healthcare is both a right and a responsibility.  The responsibility, it seems, is both on the part of the individual and on the part of society, globally.  From our numerous discussions, I believe we have come to agree that a great discrepancy exists between the “Have”s and the “Have- not”s in regards to healthcare access – the few seem to have a lot, while the many seem to have nothing. 

 Does it make sense that the “actual figure for U.S. foreign aid giving [is] about 1.6 percent of the discretionary budget,” less than one quarter of what industrialized countries pledged to give at the 1992 Rio Conference?  To me, it does not.  I cannot seem to justify this. 

Moreover, we have discussed various ways through which high-income countries profit from the poverty and disparity of low-income countries (outsourced clinical trials, sub-par healthcare, pharmaceutical companies, etc).  In a world that seems to be so extensively globalized, do we (as citizens of the world, and, particularly, as citizens of a high-income country) not incur a greater responsibility to give aid, if we have even the slightest possibility of doing so?  Perhaps, we do not.  Perhaps, it is fitting to say that we live in a world that is “unfair” and “doomed” and it is unlikely that a radical change will come in the future, making any attempt on the part of a single person is futile. 

I, however, am not comfortable with this.  I’d like to once again bring up Professor Alcabes’s argument, which forces us to really be honest with ourselves: either, we do NOT believe that human rights are universal, thus justifying their variance as a result of circumstance…OR, we believe that human rights ARE universal, therefore, causing us to address the many discrepancies we have discussed.  If the human right to be free from disease, to have healthcare and clean water, to be protected from exploitative research experiments, to have information, etc. is not merely a moral aspiration, then I believe that there is a universal responsibility on the part of all people to protect this right.

 I am not delusional about the sad realities of the world we live in; however, great things have been achieved by people who refused to accept these realities as being inescapable.  Perhaps, a persistent discomfort on our part may also bring about a change. 

AFP reports that the Indian drug manufacturer Cipla will drastically reduce the price of three important cancer drugs — each of them under patent to one of the big western pharmaceutical firms.  With Cipla’s new pricing scheme, the drugs will be purchasable for about 25% of the price charged by the patent holders, Bayer, AstraZeneca, and Schering.

As the Wall Street Journal reports, the break point came when the Indian patent office required Bayer to grant a license to an Indian manufacturing firm (not Cipla, actually) for its liver/kidney cancer medication Nexavar.

The head of the European Federation of Pharmaceutical Industries and Associations said that the companies would prefer to make drugs affordable through so-called tiered pricing schemes, wherein the price of a drug varies from country to country in regard to local cost of living.

In a 2009 article in Global Health magazine, Andrew Jack notes that some big pharmaceutical companies have lowered their prices to try to compete in the huge Indian market, including selling the diabetes drug Januvia (Merck) for one-fifth its US price.  GSK, Jack notes, even has different prices in different parts of India.

Tiered pricing or patent busting — a big problem remains unresolved:  even when prices are lowered to $100 per dose, many people can’t afford them.  Last year, an article in The Economist showed results of surveys by Abhijit Banerjee and Esther Duflo:  over 90% of respondents in rural India (and about 80% of Pakistanis, 70% of Bengladeshis, etc.) live on $2 a day or less.  For such households, the cost of a single dose of cancer medication — even at the Cipla price — is equivalent to weeks worth of food.