Global Pharmaceutical Policy
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Global Pharmaceutical Policy

Ensuring Medicines for Tomorrow’s World

Frederick M. Abbott and Graham Dukes

Pharmaceuticals play a central role in health care throughout the world. The pharmaceutical industry is beset with difficulties as increasing research and development expenditure yields fewer new treatments. Public and private budgets strain under the weight of high prices and limited access. The world’s poor see little effort to address diseases prevalent in less affluent societies, while the world’s wealthy are overusing prescription drugs, risking their health and wasting resources.
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Chapter 9: The Rich, the Poor and the Neglected

Frederick M. Abbott and Graham Dukes


Problems in ensuring access to medicines are in no sense limited to the developing world. In high-income countries there are generally sufficient budgetary resources to supply entire populations with needed treatments, but because of inequalities in wealth distribution and as a consequence of government policy failures, significant access gaps remain. On the reverse side of the coin, high-income countries face a largely unaddressed problem of over-consumption of medicines, the causes of which include poor prescribing practices and commercial promotion of treatment. And in the meantime a considerable number of illnesses, many of which in principle might be eligible for some form of medicinal therapy, remain neglected by researchers. In several of these matters one is in effect dealing with a state’s duty to minorities. Such a duty is well recognized in international law, where the minority is characterized in terms of ethnicity or religion and the state’s duty towards it is primarily a question of respecting its rights and practices.1 By analogy, however, one might well consider that a state has an obligation to afford a disadvantaged minority a degree of special treatment, enabling it so far as possible to overcome its impediments, whether the latter arise from poverty, age or the burden of a rare disease. This is hardly an extrapolation from existing law, rather an interpretation of it. It has often enough been argued that the state has a duty to eliminate poverty and, so long as it has not been eliminated, to provide relief from its most...

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