Ethics

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The Path Of The Great Prophets

Published by Anonymous (not verified) on Mon, 30/11/2020 - 8:51pm in

Tags 

Ethics, Religion

A religion is an ideology with supernatural elements.

We consider it OK to criticize Marxists or capitalists or libertarians or monarchists, but we tend to shy  away from saying that a religion has bad elements.

The Hindu caste system is evil. It needs to end, and it needs to end today. If The Laws of Manu sanctify it, they need to go or be reinterpreted, whether they are a holy document or not.

All religions which claim that non-believers automatically are damned need to change that because it leads to things like crusades and jihads and burning people at the stake to save their souls.

God also does not have a chosen people, and claiming it does leads to obvious problems.

Male “leadership” needs to go away as well.

Prophets are great men (there don’t seem to be many women prophets) and most of them did more good than evil.  Codified religion, however, generally winds up missing the point. Muhammad, for example, made the lot of women far better than it was before. He improved it. His followers took the better status he gave them (still less than men’s) and said “OK, this is it” or they backslid, rather than noting the direction of movement: forward.

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Confucius put human relationships at the center of his teachings, but denigrated women and put only one relationship involving women as important: the husband wife bond. His teachings, resting in the family, also had a tendency to lead to nepotism.

Jesus, poor bastard, had his teachings bastardized more than almost any great prophet I can think of: a Christianity which includes the book of Revelations has lost the plot, and I suspect the Old Testament should be ditched as well, because the God of the Old Testament acts in ways opposite to what Jesus teaches.

Great prophets are not perfect, they don’t get everything right. Their successors are usually their lessers, and get even more wrong.

Senator Carl Schurz once said, “My country, right or wrong; if right, to be kept right; and if wrong, to be set right.” This is the correct attitude in religion, as well.

Religion is often wrong, and the great prophets were not always right. You take the good and jettison the evil. If a great prophet tells you to do evil: to enslave people, or to murder, or to oppress, it is still evil. To abnegate to them your moral responsibility is not the road to God or good, it is the road to Hell.

Religious followers who fall back on authoritarianism “my prophet/god said so, that’s why” are not due a pass because they have a religion. If what they’re doing is wrong, it’s wrong no matter what authority they claim. A God who is not good and does not want its followers to do good is no God anyone should follow.

What is especially ridiculous is that almost everyone who has a religion was born into it. Converts are actually quite rare. So people follow a set of beliefs they didn’t choose just because of where and who they were born to. (Not that this is unique to religion.)

The person of reason; the moral person, takes these beliefs as arbitrary and inquires as to what parts are good and bad, rather than bowing down before tradition and authority.

This is the path of respect for the great prophets, each of whom came into an imperfect world, was unwilling to accept it, and tried to make it better. Buddha saw suffering and sought a way to end it. Confucius saw rulers savagely mistreating their subjects and sought to bring better rule. Jesus saw people following “the law” and missing the spirit of love and care for fellow humans that was the essence of the love of God. Muhammad’s first followers were mostly women and slaves (as was true of early Christianity) because he offered them a better life than the one they had.

It is that spirit: the spirit of improvement, of movement towards the good, that is the legacy of the great prophets. If you are not doing that, no matter how pious, you are not following their example. By not striving to improve on what they got wrong, left undone, or their successors messed up, you disrespect them more profoundly than anyone who takes their name in vain but tries to do good.

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Our Society Is Built on Lying and Breaking Faith

Published by Anonymous (not verified) on Wed, 18/11/2020 - 8:27am in

Tags 

Ethics

Came across a long story about a man’s military career. Basically, he was a West Point graduate and refused to lie: He wouldn’t sign forms that he knew were wrong. He lasted four years in the military, because almost everything he had to sign was a lie, and he wouldn’t do it.

This is worth a long quote:

Readers may regard the anecdotes above as mildly interesting, but trivial because rifle serial numbers and vehicle status are not that important in the grand scheme of things. They would be more impressed if I had refused to sign a document covering up an atrocity or something like that.

In corrupt organizations, whether it be Enron, the NY Police Department during the time that Frank Serpico was an officer, the Mafia, or the U.S. military, newcomers are tested before they are “trusted.” As Al Pacino said over and over in The Recruit, “Everything’s a test.”

Relatively new NYPD officers like Serpico, also played by Al Pacino, were invited to accept small bribes to show they were “one of us” before they were permitted knowledge about bigger stuff. Mafia wannabes are required to commit crimes confirmed by Mafia guys before they are allowed into the inner circle.

This has two purposes:

• to identify and screen out any “boy scouts” or undercover agents who are squeamish about corruption

• to get something on everyone so no one can later change his mind and snitch

Signing false documents is a court martial offense. It violates the Uniform Code of Military Justice. If you sign a false document, you both gain entry to the “club” and you put yourself in a position where you cannot get out because if you ever go over to the media or authorities, they can trot out the false documents they know you signed to discredit and court martial you.

He goes on to talk of applying to be a real-estate salesman. They wouldn’t hire him because he had a rental property himself, had money in the bank, and no dependents. In other words, he didn’t need the money and therefore couldn’t be coerced by his boss.

A vast amount of life is like this. In my old corporate career, I remember being in a legal compliance meeting (the most junior person there). There was a discussion of a law, and the senior VP wanted us to simply track possible violations, not stop and report them. I read out the key section of the law and said “I don’t see how that law can be read as “just keep a spreadsheet.” He insisted. I said, “Of course, you’re the Senior VP. Just write a directive telling us to do that and sign it.”

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We obeyed the law. But I was never invited to another such compliance meeting. Of particular note is that I was the only person who stood up, even though there were half a dozen people in the meeting, many senior to me, and I know some agreed with me. But they had careers, families, and were already compromised. In fact, of course, I protected them: They are the people who would have taken the blame, not the VP, if a regulator ever actually called us on it, because no way was that VP putting his John Henry on the directive.

This sort of thing goes all through modern life. We compromise (and I haven’t always stood up, though I’m pretty stiff-necked). Often it isn’t illegal, per se. It’s lying to employees (yeah, they actually probably are going to lose their jobs, but we can’t tell them that yet.) It’s hurting employees to make a number on a spreadsheet you know doesn’t actually matter, but senior management wants that number and standing up to senior management is a bad idea, you have to just give them what they want all the time so they think you’re a go-getter.

Of course, in many cases the best way to give senior management what they want is to lie. Move those numbers from one quarter to another; count future income now, or income that’s probably going to happen as for sure. If all that doesn’t work and it’s not something they can know without knowing more about operations than they ever do, just lie to them.

Sometimes this happens pro-actively, sometimes it’s a response to management who won’t listen. “I don’t care that it can’t be done, make it happens.” OK, buddy, if you won’t listen, I’ll just change the numbers.”

These things are rife. On Wall Street in the 00’s, everyone knew that whole classes of mortgages were based on lies. They were actualy called “liar’s loans.” It was common knowledge. Everyone knew that there was housing bubble (except a lot of economists, who are great at lying to themselves) and there they were  telling clients that real-estate is a sure thing. Goldman Sachs was telling their clients everything was fine while they placed a huge bet on the other side.

The entire economy, and most of politics runs on lies (Obama lied about everything of importance to progressives, to their faces. Trump of course, doesn’t tell the truth, and probably doesn’t know the truth. But no one cares because he’s just more extreme about what is normal.)

You make these compromises, over and over again, and they kill your soul. You must believe that this is okay, that it’s how things are done, that it doesn’t make you a bad person.

But it does. It makes you a bad person. Doesn’t make you nothing but bad, you, like Joe Biden, probably love your son or family or dog or something.

A society where you must lie, repeatedly, to get power, where you must do evil over and over again to get power (or even a decent living) will be shit, and the more the virus of dishonesty and meanness spreads, the more shit it will be.

This is why the one thing I try to do as a writer is always tell the truth as I know or believe it to be. Might be wrong, but I’m not lying when I say something. The only time I ever didn’t tell the truth as I knew it was for about two weeks around Obama’s victory period when I made the mistake of trying to influence his incoming administration by offering the sugar plum vision of how popular he could be if he was the next FDR. It was wrong to do, a moral failing and mistake, and I’ve never forgotten it.

You lie and you compromise yourself. It’s that simple. I was lucky, I could walk back, admit the wrong (I’ve written about this before), and continue on. But the more you do it, the harder it is, and, in many cases, if you’ve done serious wrong-doing, you’re compromised for life.

I don’t know an easy way out of this. The fact is that we have created a self-perpetuating hell. I do know that a lot of it comes down to fear; that the more we make the good life something only some people can have, with the price always being compromising yourself (don’t kid yourself, not one percent of corporations actually don’t require managers to compromise themselves in multiple ways), well, people crumble. They’ve got that dog or son to look after or they’re ambitious and hey, everyone does it, so if the price is lying and fucking every worker who reports to them, they do it.

So the first step, because people are weak and scared, is to create a society where everyone’s needs are met at a decent level; where losing your job doesn’t mean plunging into poverty. This is something almost no one has done, in Canada you certainly don’t want to be poor, it’s ass, let alone in the US where it means life in Hell, and then probably an early and degraded death.

Faced with a life of misery or an end to their integrity, most people will lose their integrity. When that’s almost everyone with any power, well, your society will be hell.

And those are the societies most of us live in. (Remember all the oil companies and tobacco companies lying? Yeah.)

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I Suffered, Therefore So Must Others

Published by Anonymous (not verified) on Tue, 17/11/2020 - 7:56am in

I want to expand on this idea, ably put my Amal El-Mohtar here:

This idea seems right: the first is better than the second.

But the actual correct stance is:

This bad thing never happened to me BUT I can imagine how horrible it would be, so I want to make sure it doesn’t happen to other people.

None of us, no matter how bad our lives are, have experienced all the horrible things that can happen. Conservatives are notorious for being terrible except about one thing, you dig and it’s “My child got esophagal cancer so now I champion that,” OR “Someone I care about was shot with an assault rifle so now I’m against that.”

Imaginative empathy allows us to imagine being a blood diamond slave in the Congo, or there during a school shooting, or suffering from grinding poverty even if we’ve had good lives. It allows us to be disgusted and horrified by people cleaning out sewers by hand (Indians euphemistically call this “manual scavenging”) or what it’s like to suffer from anti-black racism or caste oppression. We don’t need to have suffered something either to say, “Others should suck it up,” or “Others shouldn’t have to go through what I did.”

This isn’t a call to removing all risk and stress from life. Not all unpleasant events are bad. The general rule, now well-supported by various studies, is that short term stress is good, and chronic stress is bad.

When I went to school, we had exam hell week: one before Christmas, one at the end of the year. The final exam week usually determined 50 percent of our marks.

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This arrangement made for “good stress:” it was short-term and made you learn how to take high-impact tests. I’ve never feared a test since then: I assume I can pass any academic test, if given enough time to study, and my idea of enough time is a lot less than most people’s.

We don’t want to protect people from good stress — from short term challenges that teach them what they can do.

Chronic stress or traumatic stress, however, we do want to avoid. No one is improved by rape (prison administrators take note). No one is improved by being poor for years or even months on end. No one is improved by chronic hunger or fear.

The larger questions are why some people are unable to employ imaginative empathy: Why they must experience hell first-hand to realize “Oh! Hell is bad!” and why some can’t extrapolate this to “All hells are bad.”

Life is better with happy, healthy people. Heaven and Hell are both other people: if you’re surrounded by happy, loving people, odds are you’ll be happy. If you don’t start that way, you’ll almost certainly wind up that way. We shouldn’t want our fellow citizens to be subject to damaging long-term stress of traumatic events simply because we have to live with them.

The exception, alas, is that some people can’t learn that something is bad if it doesn’t happen to them. Their depraved indifference is a danger to everyone around them and a challenge to ethics. The people who need to be poor or spend time disabled or seriously sick are the people who think it’s no big deal. Some people, it seems, can only learn that “Hell is bad” if they or perhaps someone they love, spends time in Hell.

El-Mohtar’s tweet, of course, was about the possibility of Biden using an executive order to forgive $50k of student debt.

The good way to do it would be to get rid of the bankruptcy bill Biden pushed that made it impossible for student loans to be discharged in bankruptcy, which would sort the situation out fast (it is NEVER a good idea to make it so that creditors do not have to worry about non payment. NEVER.)

But Biden probably won’t have control of Congress, and this is better than doing nothing, even if some people who have paid off student loans feel it is “unfair.” It was unfair they had usurious loans, but just because they suffered doesn’t mean others should.

The best solution, of course, would be to go back to 60s-style universities where tuition is either cheap or non-existent. The cost is a lot less than any of the repeated bailouts of rich people and could be made even lower by doing something about university admin bloat (that’s an entire other article I may write one day) and a more complete solution would be to do something about credential inflation: Most jobs don’t need a degree and the idea that they do today is absurd.

But what Biden can do is forgive $50K with an admin order and he should. It’s a good thing he can do, and if it doesn’t relieve the suffering of people in the past, well, hopefully you are, at least, the sort of person who doesn’t want others to suffer like you did.

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Corruption in the medical-political complex

Published by Anonymous (not verified) on Mon, 16/11/2020 - 7:20pm in

The British Medical Journal had an editorial last week that pulled no punches. It began by saying:

Politicians and governments are suppressing science. They do so in the public interest, they say, to accelerate availability of diagnostics and treatments. They do so to support innovation, to bring products to market at unprecedented speed. Both of these reasons are partly plausible; the greatest deceptions are founded in a grain of truth. But the underlying behaviour is troubling.

Science is being suppressed for political and financial gain. Covid-19 has unleashed state corruption on a grand scale, and it is harmful to public health. Politicians and industry are responsible for this opportunistic embezzlement. So too are scientists and health experts. The pandemic has revealed how the medical-political complex can be manipulated in an emergency—a time when it is even more important to safeguard science.

It concluded saying:

Politicisation of science was enthusiastically deployed by some of history’s worst autocrats and dictators, and it is now regrettably commonplace in democracies. The medical-political complex tends towards suppression of science to aggrandise and enrich those in power. And, as the powerful become more successful, richer, and further intoxicated with power, the inconvenient truths of science are suppressed. When good science is suppressed, people die.

This is no left-wing organisation saying this. And it is not exonerating all doctors, by any means.

Instead it is a professional body suggesting there is corruption - a term it clearly is happy to use - in what it calls the medial-political complex, a term clearly based on the military-industrial complex condemned for its own political and economic corruption by President Eisenhower over 60 years ago in a parallel that is all too obviously appropriate.

The rest is worth reading. That we need to be wary is all too obvious.

More than anything else I hope for the freedom from fear

Published by Anonymous (not verified) on Sun, 08/11/2020 - 9:32pm in

Tags 

Ethics, Politics

This has to be watched.

I may be relieved today, but this is a CNN anchor making clear just how much this really matters, and just how oppressive the world he has lived in has really been:

And let’s not for a moment forget how oppressive a world we live in at present in the U.K.

We have a country that oppresses the immigrant, any person of colour, children, those on low or no pay, the north, Scotland, Wales and Northern Ireland, those from the EU, single parents - and so women - and so many more.

We too live in a country where government by fear is the mechanism of choice for those currently in office.

More than anything else I hope for the freedom from fear, because that is how we will know we live in a better world.

Ireland asked to justify its abusive tax policies and their impact on children

Published by Anonymous (not verified) on Sat, 07/11/2020 - 7:07pm in

I was delighted to note the Irish Times reporting that:

The United Nations is to examine whether Irish policies contribute to tax abuse by companies that harms children’s rights in other countries.

As they added:

Campaigners welcomed the move, arguing that “morally indefensible” Irish laws enable profits to be shifted from the developing world, damaging children’s rights.

They noted:

It is the first time tax has been included in a review of Ireland’s compliance with the UN Convention on the Rights of the Child (UNCRC). The treaty obliges Ireland to avoid policies that undermine the human rights of children at home or abroad.

As an old friend of mine commented:

Sorley McCaughey, head of policy and advocacy at Christian Aid Ireland, said that while Irish tax incentives attract investment, “they’re not without consequence. Ireland’s aggressive tax policies allow tax avoidance, and it’s often developing countries that suffer most”.

I agree, and am pleased that:

Ireland has been asked to outline measures which “ensure that tax policies do not contribute to tax abuse by companies operating in other countries, leading to a negative impact on the availability of resources for the realisation of children’s rights in those countries”.

The move is a success for tax campaigners, As The Irish Times notes:

The UN made the move after a submission from a group of Non-Governmental Organisations (NGOs), including Christian Aid Ireland, the Global Legal Action Network (Glan), Oxfam Ireland, ActionAid Ireland and the Tax Justice Network.

Good work by all involved, I say.

There should be no platform for lying politicians – until they learn to tell the truth

Published by Anonymous (not verified) on Fri, 06/11/2020 - 7:35pm in

Tags 

Ethics, Politics

I'm not sure I need to add much to this:

Except that is to say I am utterly bored of UK interviewers not challenging blatant lies from ministers, in particular.

Much of the US broadcast media cut off Trump for lying yesterday. They were right to do so. But we should now consider how all politicians should be held to account for their lies. Democracy depends on this happening.

And Johnson is consummate at it. As Rory Stewart wrote in the Times Literary Supplement  yesterday:

Johnson is after all the most accomplished liar in public life – perhaps the best liar ever to serve as prime minister. Some of this may have been a natural talent – but a lifetime of practice and study has allowed him to uncover new possibilities which go well beyond all the classifications of dishonesty attempted by classical theorists like St Augustine. He has mastered the use of error, omission, exaggeration, diminution, equivocation and flat denial. He has perfected casuistry, circumlocution, false equivalence and false analogy. He is equally adept at the ironic jest, the fib and the grand lie; the weasel word and the half-truth; the hyperbolic lie, the obvious lie, and the bullshit lie – which may inadvertently be true. And because he has been so famous for this skill for so long, he can use his reputation to ascend to new levels of playful paradox.

And yes, I am arguing that he should not get a platform for such lies. Then we might get honest politicians again. The cancer of political lying has to stop. And then, of course, every liar could have a platform again - so long as they told the truth. I am not opposed to opinion I disagree with being offered. Far from it: I will always demand that this be allowed. But lies destroy trust. And they have to end.

From tax havens to Trump – it’s all about playing the law

Published by Anonymous (not verified) on Wed, 04/11/2020 - 8:03pm in

In many ways I rather suspect that Trump cannot believe his luck this morning.

He’s won enough big states as I write before 9am to say that Biden has not, as yet, got an outright electoral victory, although he leads. And in the States left to call the delays are likely to be significant. That’s been enough for him to begin the rollout of what he always planned, which is the claim that the election will now be taken from him by fraud, which he will call upon his supporters to challenge.

Trumps claims are, of course, nonsense. We knew some states, where counting was not permitted until voting ended, would be delayed. We knew there would be significant numbers of postal votes. We knew they would be predominantly Democrat votes. We knew the rules required that they be counted. We knew there was nothing untoward in this.

But Republicans are neoliberal to the core. And neoliberals long ago learned that playing by rules was not for them.

On tax they used tax havens, and other mechanisms of tax abuse.

In business they have leveraged companies for their gain at cost to everyone else, and ultimately society at large.

Electorally, every gerrymander possible has been exploited.

They don’t play by the rules, which fair competition requires and which the left still expects. Instead they play by abusing the rules any which way they can. And the left is still surprised by that.

I have no idea why. Years ago I realised that the whole offshore world was a game of pretence. No one who uses offshore really believes there is anything that really happens in tax havens. Everyone knows that supposed offshore activity is just a charade to hide what is, in effect, a giant con-trick that is maintained solely because so many apparently credible people go along with it.

The trouble is, if you can persuade yourself that something really happens in a tax haven then eventually you can persuade yourself that almost any other attempt to arbitrage the law in your favour is legitimate. And then you believe that arbitrage itself is legitimate.

And we end up with Trump claiming victory when he quite possibly hasn’t won, and he knows that, which is why the diversionary plan - the ‘make believe’ that he will arbitrage - is put in place.

We just have to hope that this time he may be rumbled.

Philosophers On Access to Medicine

Published by Anonymous (not verified) on Thu, 29/10/2020 - 1:54am in

Three philosophers discuss some of the moral and political questions involved in providing access to medicine and medical care in this edition of Philosophers On.


[Damien Hirst, “Utopia”]

During the pandemic, the problem of lack of access to medicine, treatments, medical equipment, and care was made vividly personal to a large number of people who otherwise have the privilege of not having to worry about it. To Nicole Hassoun, professor of philosophy at Binghamton University, this seemed like an opportunity to draw attention to those people around the world who do regularly have to worry about this problem, and the questions and challenges that arise in devising a better and fairer distribution of access to medicine. She contacted some other philosophers who work on these matters and the result is this post, with contributions by her, Govind Persad, assistant professor at the Sturm College of Law at the University of Denver, and Anders Herlitz, associate professor of philosophy at the Institute for Futures Studies at Stockholm University.

The Philosophers On series contains group posts on issues of current interest, with the aim being to show what the careful thinking characteristic of philosophers (and occasionally scholars in related fields) can bring to popular ongoing conversations. Contributors typically present not fully worked out comprehensive positions but rather relatively brief thoughts that can serve as prompts for further reflection and discussion.

Thanks to Professor Hassoun for putting this together and to Professor Herlitz and Professor Persad for taking part. The individual contributions are below.

  1. “Medicine and the Global Health Impact Project” by Nicole Hassoun
  2. “How to Care About Life Expectancy” by Anders Herlitz
  3. “What Sort of Access to Which Medicines?” by Govind Persad

Medicine and the Global Health Impact Project
by Nicole Hassoun

As the Coronavirus pandemic surges around the world, for the first time, many people in developed countries realize what it means to lack access to essential medicines. Must governments, the international community, or pharmaceutical companies extend access to these medicines around the world and, if so, how should they do so?

In the United States, the idea that people have a right to health is controversial. People generally need private health insurance to access adequate care, and although we’ve seen some changes in recent years, the legal right to health articulated in international law is not one that the United States has fully endorsed.

In my book, Global Health Impact: Extending Access to Essential Medicines , I defend the idea that everyone should (morally) have this legal right to health, it should be enforced, and people should be able to access essential medicines as one part of that right. I believe that the right is justified because it protects everyone’s ability to live, what I refer to as, a minimally good life. As I believe the human right to health is articulated in an international law, different agents have different obligations to help people secure access to medicines. In the book, I also argue that human rights should inspire us to think creatively about how to better meet everyone’s basic health needs. I believe that these arguments can guide our response to the COVID-19 pandemic and help us better prevent and address other health crises.

The human right to health should, and often does, give rise to a virtue I call creative resolve,a fundamental commitment to overcoming apparent tragedy. This right helps us respond to a mindset focused on scarcity, which necessitates rationing essential resources, such as medicines.

One of the most prominent objections to a legal human right to health, at least in the United States, and in the philosophical literature, is that it is unrealistic. One worry is that, if we must help everyone secure a basic minimum of health, there is not much else we will be capable of doing. Moreover, people have other rights (e.g. a right to education), and this requires us to consider trade-offs between fulfilling these rights. I believe this depends on how you perceive the human right to health and the obligations it generates with respect to other competing obligations. However, I do not think we should reject a legal human right to health because it is expensive or because we need to ration health care. The right to health can, and should, do something much more important for us: It should inspire us to find new ways of fulfilling the right and, thus, help reduce the need to ration.

I believe commitment to the human right to health can help us extend access to healthcare significantly. I follow Amartya Sen who says that when we think of health as a human right, that is a call to action to advance people’s health now in the way 18th century activists fought for freedom and liberty. So, when I talk about the virtue of creative resolve—that fundamental commitment to trying to fulfill the right insofar as possible and permissible—it takes into account other things that matter. And more specifically, it requires us to do things like question evidence that we cannot fulfill the right, seek out creative ways of doing so, and act to fulfill it.

Consider the fight to extend access to essential medicines for AIDS. By the 1990s, people in Europe and the US were living long and healthy lives due to antiretroviral drugs, but around the world, millions of people still couldn’t access those medicines and were dying from the disease. The cost of antiretrovirals was about $12,000 per patient per year and pharmaceutical companies claimed it was impossible to lower the prices. But human rights activists refused to accept this claim. They were going to find ways of making access to medicines possible and they came up with creative ways of extending access. They galvanized a global movement to do that by educating patients about their rights and shifting public opinion on access to help bring that price down from $12,000 per patient per year to about $350 per patient per year. The history of public health is replete with similar stories about the fight against other diseases like smallpox, polio, Ebola and tuberculosis.

There are many creative proposals for extending access to essential medicines around the world – including proposals to incentivize new innovation and proposals to extend access to existing drugs and technologies. We require a broad array of different possible solutions to ensure solving the access to medicines problem.

My own attempt to think creatively about how to extend access to essential medicines around the world is an initiative called the Global Health Impact Project (GHI). The intention of GHI is to incentivize positive change by evaluating the health consequences of medicines for some of the world’s worst diseases. I launched the scientific part of this project at the World Health Organization in 2015 and relaunched some of our newer models at Princeton University last year. Having this information can help de-link pharmaceutical companies’ incentives from profits and encourage them to focus on alleviating the greatest amount of need possible. We can encourage companies to save more lives and alleviate more disability using data by tying existing proposals for extending access to requirements to increase Global Health Impact (e.g. advance market commitments can be based on the health impact of resulting innovations). In the book, I discuss how consumers can use the information from this index to decide which products to purchase. So if you have two otherwise equivalent products from two different companies and one of those companies is having a great Global Health Impact with their medicines, you might reasonably prefer to purchase things from that company, you can think of it like fair trade for global health. Companies care about their reputations and could profit from these labels. Socially responsible investors might also care about companies’ Global Health Impact – for some time, Sanofi was using our label, along with other rating systems, on their website. Universities also produce a lot of the drugs and technologies that companies rely on, so if universities made it a condition of the sale of their licenses that companies have a high Global Health Impact, that could also make a difference. Together these ideas might create incentives for companies to get themselves highly rated, and these incentives may equate to better access to essential medicines.

Policy makers can also tie the Global Health Impact measurement to things like global prize funds. If you reward companies for new innovations based on their Global Health Impact, that gives them an incentive to focus on diseases such as AIDS, malaria, and TB that are causing death and disability around the world, and less to catering to rich patients, which is currently their most lucrative option. Policy makers can also use the Global Health Impact Index in thinking about restructuring laws such as the Orphan Drug Act, which gives companies a large incentive to create drugs that do not have a large market in the US. It could be useful to reward companies for these new innovations only in proportion to their Global Health Impact.

Finally, I think information on Global Health Impact is important for health systems planning and resource distribution. The World Health Organization, the TB Alliance, USAID and other health organizations need to know where they are having an impact and where they are not, to set targets, measure progress, and improve health.

When it comes to the Coronavirus, I think some of these proposals can help. Now is a good time to radically restructure the incentives for pharmaceutical research and development, there simply should not be any patents in a pandemic. 80% of manufacturing capacity is for generics, we cannot use this capacity if we let companies maintain patents on their products. We should instead reward them on the basis of total Global Health Impact. And, if we cannot do that, we should find other creative ways to help everyone secure the medicines they need, by joining the COVAX initiative, doing compulsory licensing, and employing other innovative proposals for helping people access essential medicines now.

(This post draws on the New Books in Medicine podcast on the book that may be of interest to readers, as well as ideas in several op eds.)

How to Care about Life Expectancy
by Anders Herlitz

The COVID-19 pandemic actualizes philosophical questions about whether life expectancy matters when one must choose which life to save when not everyone can be saved. Such choice situations might arise when intensive care units are overcrowded, when therapeutics such as remdesivir are scarce and when scarce vaccines are distributed. I will here suggest that life expectancy does matter, but that it matters in a clumpy way.

Consider the following situation:

Big Difference: Two 50-year-old men, Charles and David, urgently need a life-saving treatment for a health problem they are not responsibility for and are expected to die in 3 weeks if they do not get the treatment. However, there is only one treatment available. If Charles receives the treatment, he is expected to live a life of good health for another 10 years. If David receives the treatment, he is expected to die in 4 weeks from unrelated health problems.

I believe that in this situation, one should save Charles’s life and the fact about the situation that leads to that conclusion is that Charles’s life expectancy is significantly greater than David’s.

Several ethical theories pick up on this factual difference between Charles and David and refer to it in order to support this conclusion. Here are three appealing ethical approaches that do that:

Consequentialist approaches
Consequentialist theories (e.g. utilitarianism, prioritarianism) say that you ought to do that which has the best consequences. These theories typically satisfy anonymity axioms so that it does not matter who enjoys what benefits. Insofar as one accepts that it is a good thing that someone lives between the age 50 and 60, it has better consequences to save Charles. From a consequentialist perspective, the only relevant difference between saving Charles and David is that saving Charles amounts to an outcome where one person dies at age 60 and another person dies at age 50 + 3 weeks, while saving David amounts to an outcome where one person dies at age 50 + 4 weeks and another person dies at age 50 + 3 weeks.

Contractualism
According to contractualism, one ought to follow the principle which no one can reasonably reject. A popular contractualist idea is that: “an individual can reasonably reject a principle if her level of well-being and burden, given widespread acceptance of that principle over her lifetime, combine into a complaint greater than that had by anyone else about some alternative principle, given widespread acceptance of that alternative over a lifetime. (Reibetanz 1998: 300)”

The largest complaint that can be charged against a principle that says one should be indifferent toward saving Charles or David is plausibly equal to David’s prospective loss (assuming you flip a coin, 0.5 * 10 years). The largest complaint that can be charged against a principle that says one should save the person with greatest life expectancy is equal to Charles’s loss (i.e. 1 week). The strongest complaint against a principle that recommends saving the person with the greatest life expectancy is the smallest (1 week vs. 5 years).

Harm-based approaches
According to the so-called deprivation account of the badness of death, dying is bad because and to the extent that it deprives a person of something. The more it deprives someone of, the worse the death. It is worse to be deprived of 10 years of living than to be deprived of 1 week of living. Paired with the idea that one ought to prevent the biggest harm possible, the deprivation account of the badness of death favors saving Charles.

However, as appealing as these approaches might be, they seem to generate unpalatable recommendation in other cases. Consider:

Small Difference: Two 50-year-old men, Eric and Fred, urgently need a life-saving treatment for a health problem they are not responsibility for and are expected to die in 3 weeks if they do not get the treatment. However, there is only one treatment available. If Eric receives the treatment, he is expected to live a life of good health for another 10 years. If Fred receives the treatment, he is expected to live a life of good health for another 10.1 years.

I propose that in this situation—contrary to what the approaches outlined above seem to suggest—it is not at all obvious that one should save Fred’s life based on the fact that his life expectancy is greater than Eric’s. By contrast, I think that it is appropriate to give both Eric and Fred some chance of receiving the treatment in this case. Fairness requires that we treat roughly similar claims in similar ways.

To account for the intuitions that at least I have in Big Difference and Small Difference, one needs a principle that allows for differences in life expectancy to guide action in some but not all cases, i.e. the principle must accept clumpiness regarding the value of saving lives with different life expectancy. Here is one such principle:

Clumpy Maximization: If and only if one of the available acts, a, saves a life with significantly longer life expectancy (if saved) than any of the lives that otherwise could be saved, then there is a pro tanto reason to do a.

Applied to healthcare policy and choice situations actualized by a pandemic, Clumpy Maximization does not say that healthcare practitioners and distributors of scarce health-related resources make fine-grained assessments of what patients would live longer if their lives were saved. In this way, it is—presumably—less controversial than some alternative principles that ascribes importance to life expectancy. At the same time, Clumpy Maximization does say that when the choice is between someone with a potentially long future ahead of them and someone with a relatively short future ahead of them, there is a reason to save the person with the greatest life expectancy, which is something I believe any plausible approach really must imply.

Much more must of course be said about how to operationalize and interpret Clumpy Maximization. What counts as “significantly” longer? What should be done when there is no significant difference in life expectancy? How should the principle be applied to large choice sets? Does it—as I suspect—run into problems with rationality requirements? What should be done if that happens? And how strong is the reason to save the life with the longest life expectancy? How does this reason compare to other possibly valid considerations that have been set aside by the set-up of Big Difference and Small Difference but might be relevant? For instance, there might be reasons to prioritize significantly younger patient, there might be reasons to save the greater number of lives, and there might be reasons to maximize positive aggregate health impact more generally (i.e. taking into account both lives saved and other health impact). How does the reason expressed in Clumpy Maximization compare to these considerations?

What Sort of Access to Which Medicines?
by Govind Persad

Two issues are central to the ethics of access to medicines. First, defining access and understanding tradeoffs between different types of access. Second, understanding which medicines should be understood as essential and how increasing access to some medicines might compete with increasing access to others.

Access, Availability, and Affordability

One dimension of access is availability: whether a given medicine is developed and sold. Another is affordability: whether people can afford to purchase the medicine without financial hardship.

Affordability depends on three factors: (1) the funds available to the buyer, (2) financial help from third parties like health insurers, governments, or NGOs, and (3) the price charged by the seller. A generic statin for high cholesterol that costs $1 a day may be affordable for most people in Switzerland or Japan, but not for most in Mali or Turkmenistan.

Policy choices can affect each of these variables, and each presents trade-offs. Policymakers can relieve the burden on buyers by having third parties pay part of the price sellers charge. They can do this by mandating that insurers cover certain medicines, or by directly paying for some medicines. The merits of third party payments depend on their opportunity costs and on the incentives they create. For instance, when policymakers mandate coverage, they create incentives—sometimes unintended ones—to develop drugs that insurance will cover. Policymakers could also try to improve buyers’ purchasing power through cash transfers or programs to increase wages. But unlike with third-party payment, buyers might elect to spend these funds on something other than medicine–food, shelter, education, or leisure—which might improve well-being but not access to medicines.

Second, policymakers can work to lower the prices sellers charge for medicines. They can do so by direct price regulation; by shortening patent terms, weakening IP protections, or removing other barriers to market entry; or by providing incentives for lower pricing. Lowering prices has the potential consequence of decreasing availability, because firms may be less willing to invest in developing drugs if they will be unable to charge high prices for them. Nevertheless, affordable access to a smaller menu of medicines may be preferable to the formal availability of a larger menu of medicines. Efforts to lower prices may be especially justifiable when they serve to encourage the development of medicines with more social value, discussed next.

Which Medicines are Essential?

Many fundamental needs are universal. Everyone needs clean water. Everyone needs food with essential nutrients and shelter to protect them from the elements. While there are cultural differences in the foods people eat and the style of shelter they prefer, most people can benefit from most food and shelter. A Swiss family could safely shelter from a storm in a Malian mudbrick house and obtain nutrition by eating millet for breakfast; a Malian family could safely shelter in a stone house and eat muesli.

Some medicines are like food or water—valuable for, and essential to, everyone. Almost everyone, during their lives, will need and benefit from medicines that treat pain, such as acetaminophen, or address ubiquitous illnesses, such as vaccinations against diseases like measles and antibiotics that treat infection.

But many medicines are essential for some people but not others. A dose of insulin that would be dangerous for most can be a necessity for some with diabetes. Chemotherapeutic drugs are toxic but can help cure cancer. Coagulation factor, which can cost more than $100,000 per year for people with hemophilia, is not helpful for those whose blood clots naturally.

The heterogeneity of medical needs makes defining essential medicines challenging. One place to start might be with medicines, like antibiotics, vaccines, and analgesics, that meet universal needs, with a special emphasis on medicines that help meet urgent needs in more disadvantaged settings. Although the World Health Organization is not explicit about how they develop their essential medicines list, their criteria combine broad benefits with affordability. Many developed countries, including Sweden and New Zealand, also provide a defined list of essential medicines in order to effectively negotiate for affordable access.

Current economic incentives for pharmaceutical innovation, however, do not match up well with a plausible definition of essential medicines. This is especially clear for antibiotics and vaccines, which are recognized as areas of underinvestment even though innovations in these areas would have enormous and widely dispersed benefits, as the example of a COVID-19 vaccine shows. Instead, current incentives encourage innovation that benefits people with greater ability to pay, or that insurers will reimburse more generously. Many countries even encourage developing medicines that will benefit fewer people, by treating less common diseases, rather than aiming to benefit more people by improving treatment for widespread conditions.

As I argue elsewhere, policies for access to medicines such as value-based price regulation would encourage the development and provision of medicines whose benefits are greater and more broadly shared, especially those that better or more cheaply prevent and treat conditions—like malaria, tuberculosis, and HIV infection—that are particularly widespread among disadvantaged people. So might other approaches like prizes.

Because medical needs are so variable, no definition of essential medicines, short of one that encompasses every medicine that could ever help anyone, will meet everyone’s needs. But policies that incentivize meeting more needs and meeting the needs of the least advantaged are a reasonable place to start. As Paul Farmer observes, “dying of never-treated AIDS in a dirt-floored hut in Africa is worse than dying of AIDS in a comfortable hospice in Boston after having failed a decade of therapy.” This is even truer when we compare interventions that benefit more people to those that benefit fewer: for instance, a vaccine that could prevent cervical cancer for thousands of people around the world versus a $32,000/month chemotherapeutic that extends life by less than a year for patients with a rare cancer. No plausible ethical theory regards the second treatment as more important to make available than the first. Yet current incentives for access to medicines too often do.

Discussion welcome.

The post Philosophers On Access to Medicine appeared first on Daily Nous.

Why is Amazon advising the government on procurement?

Published by Anonymous (not verified) on Tue, 27/10/2020 - 1:13am in

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Economics, Ethics

As the Mirror notes today:

Amazon is advising ministers on how to buy goods and services after Brexit, while raking in millions of pounds in contracts itself.

The Mirror can reveal the US firm was on a “secretive” panel set up by the Cabinet Office to help shape public sector procurement in future.

As they add:

Amazon has been awarded 82 central Government contracts, worth £225million, in the past five years and has a deal enabling local councils to buy supplies in one marketplace.

And as they noted:

Paul Monaghan, of the Fair Tax Mark, which highlighted Amazon’s involvement on the “secretive” panel, said it was “truly frightening”.

He said: “The manner in which Amazon is embedding itself into national and regional public procurement in the UK has long been cause for concern.

“We are close to the point where it will be impossible for anyone else to compete.”

Paul Monaghan was not alone in his criticisms:

Amazon has been criticised for its track record on paying UK corporation tax. TUC boss Frances O’Grady said: “Amazon’s reward for its exploitative business model is a seat at the table on an influential Government board advising on public procurement, on top of the multi-million-pound Government contracts it receives.”

As the Mirror noted:

Amazon declined to comment.

The Cabinet Office refused to comment on the firm’s involvement, but said: “This panel is an important part of our engagement as we look to improve procurement rules.”

They are, of course, at liberty not to comment. But others are free to question, and I do.

Amazon is not in the position of a normal business: it is an effective monopoly supplier in some sectors, and has very few competitors in others e.g. large-scale computer hosting. This does not make its experience representative. Nor does it broaden the base of suppliers to government, which is one of the few things that Brexit might deliver.

So what is going on here? I think that the Fair Tax Mark is entirely right to ask, even whilst noting that I am an advisor to it, whilst also recording that I had no part in developing this story.

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