By Devin van Dyke
Medicine is a resource, and, like many resources, our ostensibly sophisticated society has not quite figured out its fair distribution according to need. Systems of supply and demand send goods around the world from their sources to wherever they can earn the most profit–medicine is no different. The result of this arrangement is that those with the least purchasing power are left out of access to resources. When the resource in question is medicine, and the outcome of its uneven distribution is widespread death and suffering caused by curable diseases, the ethics of our current system are called into serious doubt.
The World Health Organization (WHO) publishes a list of the bare necessities of a healthcare system, the WHO Model List of Essential Medicines. According to the WHO, “essential medicines are medicines that satisfy the priority healthcare needs of a population. They are selected with regard to disease prevalence, safety, efficacy and comparative cost-effectiveness.”
According to the WHO, the last time this survey was conducted in 1997, over two billion people lacked access to essential medicines. Sufferers of diseases known to be treatable, such as malaria, sleeping sickness and HIV, are denied the drugs that would vastly improve their quality of life. Meanwhile, cosmetic procedures like breast augmentation and liposuction are widespread in the affluent world; even the emotional ups and downs of peaceful and prosperous life are the target of substantial medical spending.
The reasons for the current situation are purely economical–pharmaceutical companies do not profit from catering to the poorest people and they do not recoup their investment in research and development for medicines that would benefit the poorest; doctors generally treat those who can reward them monetarily for it. Worldwide health care is implicitly run by economics and selfishness.
Take, for example, opiate painkillers. Morphine, the active chemical in opium, and its derivatives are the most effective painkillers known in modern medicine. Morphine and codeine are on the WHO’s Essential Medicines list. The world is currently in the midst of a massive opiate shortage, estimated by the International Council on Security and Development to be equivalent to 10,000 tons of opium per year. Ten thousand tons is equivalent to 20 million pounds or 9.1 billion grams of raw opium, or 1.2 billion grams of morphine (typical morphine content is 10-16 percent). A typical dose is 15 milligrams. The world is short about 80 billion dosage units of morphine in a typical year.
Meanwhile, in the United States, the most widely prescribed drug is Vicodin, an opiate painkiller prescribed 128.2 million times in 2009, according to Forbes. Why does the U.S. have such wide access to this drug? Do Americans suffer more pain than people in other countries? I doubt it–we live comfortable and painless lives compared to the vast majority of the world’s people. In fact, Americans seem to be using a great deal of their opiate painkillers recreationally–an estimated 20 percent of us have used prescription drugs for nonmedical reasons, according to the National Institutes of Health. It is unconscionable both that we have this preferred status in regard to medicine access and that we add insult to injury by using such necessary medicines to obtain a cheap high. Healthcare is broken–not only in this country, but worldwide.
However, this is not to say that the outlook is entirely bleak. There is reason to believe that the situation is improving and no reasons but cynical generalizations about human nature that we will not eventually figure out a fair and ethical worldwide healthcare system. The twentieth century was a time of great triumphs in medicine. Diseases like smallpox and polio were beaten back, and advances in sanitation have led to reduced rates of infectious disease and mortality. The infant mortality rate declined from 152 to 47 per 1,000 births from 1950 to 2008, according to a UN report. The percentage of people with access to essential medicines increased from 50 percent to 65 percent over the 20 years from 1977 to 1997. These are promising statistics, and the work done by organizations like the WHO and Doctors Without Borders continues to improve the state of global medicine. I have a lot of hope for the future, but I also know that we have a very long way to go.