Benefiting from Biotechnology: Pro-Poor IPRs and Public-Private Partnerships

February 24, 2008

Baris Karapinar and Michelangelo Temmerman, Benefiting from Biotechnology: Pro-Poor IPRs and Public-Private Partnerships (2007). NCCR Trade Regulation Working Paper No. 2007/35 Available at SSRN.

The Green Revolution has contributed to the alleviation of poverty and hunger for hundreds of millions of people, but it remains technically and institutionally limited. It has largely bypassed small farms located in dry agro-ecological regions and its institutional ‘top-down’ approach was not equipped to address social, economic and environmental variations at the local level. However, with new developments in biotechnology, including genetic engineering, unprecedented possibilities for addressing the needs of smallholders in developing countries have arisen. Yet, there are new challenges too. The new technology is driven by the private sector, which is not attracted to investing in research on developing biotechnology specifically addressing the needs of small farms. Moreover, the accessibility of the existing technologies to small farms is arguably impeded by the intellectual property rights (IPRs) leading to monopoly prices and hindering technology diffusion. In this context, this paper analyzes how IPRs can be domestically tailored within the existing international commitments so as to encourage the development of technologies that favor and are accessible to small-scale farmers in developing countries. In particular, it proposes, for the first time, a special IPRs regime designed for public-private partnerships (PPPs), which would go beyond contractual arrangements and provide a more favorable institutional climate for the development of pro-poor and pro-small-scale biotechnology.

Reassessing the Judicial Treatment of Medical Futility Cases

February 24, 2008

Thaddeus Mason Pope, Reassessing the Judicial Treatment of Medical Futility Cases. Marquette Elder’s Advisor, Vol. 9, 2008 Available at SSRN.

Over the past twenty-five years, a significant number of surrogate decision makers have demanded that a health care provider use medical technology to prolong a patient’s life beyond the point thought medically appropriate. These surrogates want to continue life-sustaining medical treatment (LSMT) that providers want to stop. While most of these futility disputes are resolved informally inside the hospital, dozens have now been litigated in U.S. courts. Because the judicial treatment of these disputes casts a long, dark shadow on the informal resolution of all the others, it is important to ascertain exactly what guidance these court cases provide.

In assessing the judicial treatment of futility cases, most of the medical, legal, and bioethical literature concludes that courts have generally disfavored providers. But these assessments are based on limited and outdated sets of cases. In this article I offer a comprehensive review of futility cases from 1983 to 2007. Based on this review, I argue that courts have generally neither prohibited nor punished the unilateral refusal of LSMT. Providers have regularly obtained both ex ante permission and ex post forgiveness for stopping LSMT without consent.

A Definition and Defense of Hard Paternalism

February 24, 2008

Thaddeus Mason Pope. University of Memphis – Cecil C. Humphreys School of Law; Widener University – School of Law. A Definition and Defense of Hard Paternalism: A Conceptual and Normative Analysis of the Restriction of Substantially Autonomous Self-Regarding Conduct, Chapter Five: A New Normative Defense of Hard Paternalism. Abstract (SSRN)

This is the key and final chapter of my doctoral dissertation. Chapters two, three, and four of this dissertation have already been published as free-standing law review articles. This chapter will also soon be published, though in two or three separate articles that link this normative jurisprudential theory to ongoing debates in public health.

In this chapter, I offer my own theory of justified hard paternalism. My theory is, as I will explain, a beneficence-based, consequentialist argument. First, because I am not the first to make such an argument, I quickly review other beneficence-based, consequentialist arguments for the justifiability of hard paternalism. I do not systematically evaluate this literature as I did with the consent-based, deontological arguments in article for the UMKC Law Review. Rather, my objective, here, is only to provide some background.

Second, in the central section of this chapter, I defend seven conditions as logically individually necessary and jointly sufficient to justify hard paternalism. I first separately argue that each of the seven conditions is necessary for justified hard paternalism. I then argue that the seven conditions are jointly sufficient for justified hard paternalism.

Specifically, I argue that hard paternalistic liberty limitation (HPLL) is justified if and only if: (1) there is strong evidence that each of the following six conditions is satisfied, (2) the objective of the HPLL is to protect the subject from significant harm, (3) the subject has either a low autonomy interest or an irrational (though substantially autonomous) high autonomy interest in the restricted conduct, (4) the HPLL is imposed only if no morally preferable, less autonomy restrictive alternatives (e.g. soft paternalism) for achieving the objective are available, (5) the HPLL has a high probability of success/effectiveness, (6) the harm from which the HPLL protects the subject outweighs any harm caused by the HPLL itself, and (7) the HPLL is least restrictive as necessary.

Third, in the final section of this chapter, I deal with the most typical counterarguments to justified hard paternalism. While I will motivate and answer a number of objections and counterexamples in the course of defending – in the middle section of this chapter – the individual necessity and joint sufficiency of my seven conditions; in the final section of this chapter, I separately state and respond to the four strongest standard objections to hard paternalism. These objections are: (1) the slippery slope argument – in both its logical and empirical forms, (2) the argument from paternalistic distance – also known as the best judge argument, (3) the argument from the developmental value of choice, and (4) the argument from the oppression of individuality.

Call for Papers: TuftScope: The Interdisciplinary Journal of Health, Ethics, and Policy

February 24, 2008

TuftScope: The Interdisciplinary Journal of Health, Ethics, and Policy is now accepting paper submissions for its Spring 2008 issue. TuftScope accepts original articles on government health policy, public and community health, bioethical matters, medical education, research in the mentioned fields, and other various issues dealing with the science and art of medicine and health or our country’s healthcare system.Papers should be 2000-3000 words in length or approximately 8-12 pages and editorials should be 1000-1500 words long in length (approximately 4-6 pages doubled spaced). Papers will be accepted until the second week of March.

For more information please contact the staff at and visit their website for complete submission guidelines and previous issues.

What’s The Ethics Of That?’ A Conversation With Thomas O. Pyle

February 24, 2008

Donald M. Berwick and Madge Kaplan. What’s The Ethics Of That?’ A Conversation With Thomas O. Pyle. Health Affairs, January/February 2008; 27(1): 143-150. Abstract

Thomas O. Pyle served in the top echelons of the Harvard Community Health Plan (HCHP) for nineteen years. In that time, HCHP became the largest health maintenance organization (HMO) in New England, and its reputation for innovation and entrepreneurship rose to the top ranks of the industry. HCHP pioneered the automated medical record, nurse practitioners, quality measurement, and sophisticated disease management. In this interview, Berwick and the Institute for Healthcare Improvement’s Madge Kaplan explore Pyle’s background, his interpretation of HCHP’s evolution and eventual transition to a much different organization, and his recommendations for the future. At the time of this interview, Tom was suffering from advanced pancreatic cancer, from which he died ten weeks later, 18 July 2007.

The U.S. Economy And Changes In Health Insurance Coverage, 2000-2006

February 24, 2008

John Holahan and Allison Cook. The U.S. Economy And Changes In Health Insurance Coverage, 2000-2006
Health Affairs Web Exclusive,
February 20, 2008. Abstract

The number of uninsured Americans increased by 3.4 million between 2004 and 2006, despite improving economic conditions. In the first four years of the decade, during a period of economic recession, the number increased by 6.0 million. The dominant factor in both periods was a decline in employer-sponsored insurance coverage. Although the recent decline was less than that experienced from 2000 to 2004, growth in public coverage was small, and the number of uninsured people increased by 1.0 million children and 2.4 million adults. Employer coverage declined most for self-employed or small-firm workers, in the South, and among noncitizens.

Essay Competition: Advise the New President on Health Policy

February 10, 2008 invites undergraduate and graduate-level students in all disciplines to submit an original essay for the web site’s annual competition. Students are asked to submit entries by March 17th. For more details visit the website:

Health Centers: An Overview and Analysis of Their Experiences With Private Health Insurance

February 10, 2008

Peter Shin, Brad Finnegan, Jessica Sharac and Sara Rosenbaum. Health Centers: An Overview and Analysis of Their Experiences With Private Health Insurance. Washington, DC: KCMU Policy Brief, Publication No. 7738, February 6, 2008.  Full text (pdf)

A new policy brief provides an overview of community health centers, with a particular focus on the relationship between health centers and the private health insurance system.  The analysis of 10 years of national data shows that health centers do not receive sufficient reimbursement from private insurers to cover the costs of treating commercially insured patients, challenging their ability to provide access to care for low-income patients.

How Non-Group Health Coverage Varies with Income

February 10, 2008

Kaiser Family Foundation. How Non-Group Health Coverage Varies with Income. Washington, DC: KFF Paper prepared by Paul Jacobs and Gary Claxton. February 2008. Full report (pdf)

With some federal and state policy makers considering ways to encourage more people to purchase non-group, or individual, health care coverage, an analysis by Kaiser researchers released this week examines how often people at different income levels buy such insurance when they do not have access to benefits through an employer or a public program. The analysis finds that relatively few people at lower incomes purchase non- group coverage, with one in 20 purchasing it among those with incomes at the federal poverty level ($18,660 for a family of four in 2003 dollars). As income increases, the coverage rate grows, though even at four times the poverty level, only about a quarter of individuals without access to alternative coverage purchased non-group coverage.

Medicaid: Overview and Impact of New Regulations

February 10, 2008

Kaiser Commission on Medicaid and Uninsured. Medicaid: Overview and Impact of New Regulations. Washington, DC: KCMU, Issue Brief prepared by Robin Rudowitz, January 2008. Full report (pdf)

In the past year the Bush Administration has moved forward with significant changes to the Medicaid program via rule-making. Taken together, six new regulations could result in an estimated $12 billion reduction in federal Medicaid spending over the next five years according to the regulatory impact statements prepared by Centers for Medicare and Medicaid Services. This brief focuses on the six new regulations that have been the source of considerable controversy and explains current policy, the proposed regulatory changes as well as the impact and issues with these changes.