A Full-Pull Program for the Provision of Pharmaceuticals: Practical Issues

Abstract

Thomas Pogge has proposed a supplement to the standard patent regimewhereby innovating companies would be rewarded in proportion to theextent to which their innovations lead to reduction of the global burdenof disease (GBD). This paper argues that an expansion of thisproposal-whereby provision of already existing medicines areincentivised in a similar way-would provide a more comprehensivesolution to the healthcare situation in developing countries. It thenconsiders the practical challenges that the implementation of such aproposal (expanded or otherwise) would entail. Though these includedifficulties associated with disease burden metric, I argue that themost serious difficulties are associated with the problem of causalattribution. A basic idea underlying Pogge's proposal is that thedisease burden reduction attributable to particular interventions can bedetermined. Theoretically speaking, in cases involving multipleinteracting causal factors, there may be no fact of the matter regardingthe extent to which disease burden reduction should be attributed to oneintervention as opposed to another; and (even if workable practicalsolutions to this theoretical challenge can bemet) the data requirementsfor implementation would be daunting.