Access to Drugs, Genomics and Bioethics in Developing Countries 169
The UNU as a Forum for Bioethics[.]
- Hamed Zakri Ph.D.,
Director, United Nations University, Institute of Advanced Studies, Yokohama, JAPAN
(Presented by A. Watanabe, Vice Director)
The mission of the UNU/IAS is to undertake research and postgraduate education on issues at the forefront of knowledge, policy development and learning. The term advanced studies refers to a multidisciplinary approach to research problems, aiming at issues of concern for the entire humankind.
One of the themes of interest to UNU/IAS is bioethics, the ethical implications of the advancements in scientific and medical technology. In June 2003 we organized together with the Embassy of France in Japan, the Embassy of Germany in Japan and the Japanese-German Centre Berlin a roundtable on “Bioethics and Biotechnology: What is at Stake for Humanity Now?”
One of the many very interesting issues emerged from the presentations was the topic about human cloning. While reproductive cloning is unacceptable to the community of nations, the big question remains cloning for biomedical research, or “therapeutic” cloning. The debate extended widely and during the November 2003 General Assembly meeting of the UN, the discussions were postponed for one year. It is therefore a highly timely research topic for our institution, to investigate the position of particularly the developing countries on this important issue. A report is to be prepared in order to be presented to the General Assembly this year, and our contribution is expected to facilitate decision and policy making in this very delicate matter.
On the other hand, we are aware that bioethics refers also to insuring basic needs such as clean water, healthy nutrition, basic health care and education to all people. As part of our biodiplomacy initiative, we will link research on biodiversity, traditional knowledge and intellectual property rights protection to access to medicine. By building a network of specialists in these fields in developing countries, our aim is to identify issues priority issues in global bioethics and bring them to the attention of policy makers.
This Roundtable, taking place concurrent with the Fifth Asian Bioethics Conference (ABC5) and the Ninth International Tsukuba Bioethics Roundtable (TRT9) will benefit from the expertise of all of you, more than hundred scholars from all over the world. National perspectives and the international dimension of bioethics have to be considered in order to reach a consensus that incorporates the concerns and features of different cultures. Bioethics is a code of conduct, a common code for all humanity, for each individual to follow. Therefore it’s universal character, which respects cultural diversity, religions, traditions and customs. Having a clear image of what is real and tangible as compared to the mirage perceived towards biotechnology, which is expected to cure all ills of humankind.
We are looking forward to the excellent results of these discussions and of the entire four days meetings here in Tsukuba and wish you all a pleasant and fruitful stay in Japan.
Identifying Priority Areas in Global Bioethics
- Mihaela Serbulea, M.D., Ph.D.[.]
UNU/IAS Postdoctoral fellow, United Nations University, Institute of Advanced Studies, Yokohama, JAPAN
Email:
Over the last century life expectancy has increased to as much as two-fold in many parts of the world. Antibiotics, vaccines, anesthetics are just a few examples of the medical progress which made the achievement possible. Organ transplantation has advanced to the extent of breaking definitions of death and religious taboos.
In the last decades, reproductive technology has facilitated birth for long-awaited children, pushing the biological barriers but also creating new challenges to family structures. Pain therapy and palliative treatment have enabled extensive surgical procedures but also raised the problem of euthanasia to be linked to the notion of human dignity. At the beginning of life, the debate on abortion continues, while new areas of terra incognita are opened. Embryonic stem cell research/therapy is seen as a panacea; the human genome project has opened large avenues of hope for the treatment of hitherto incurable diseases but also a Pandora's Box of questions. Eugenics has started to be feared again, gene therapy is still experimental and unexpected risks are becoming obvious.
The dramatic, exponential progress in science and particularly in medical technology has yet to be supported by legislation to regulate the new possibilities, which may permit the age-old dream of humankind to achieve “youth without end and life without death” to become reality.
While researchers should be free to continue pursuing effective and safe methods of treatment, the benefits, including applications in biology, genetics and medicine, should be made available to all, in line with the eighth UN Millennium Development Goal – “to develop a global partnership for development”, as stated in the Universal Declaration on the Human Genome and Human Rights: “The applications of research […] shall seek to offer relief from suffering and improve the health of individuals and humankind as a whole.”
Therefore, the UNU/IAS develops a project on bioethics with the main objective to identify gaps in bioethics research, policy making needs, and find interesting case stories from different cultures.
The UN General Assembly will reopen the discussion on the global convention to regulate human cloning. On 6 November 2003 the United Nations narrowly voted to postpone for two years the debate on competing human cloning resolutions that had divided the General Assembly. However, one month later, without a vote, the General Assembly decided to discuss the issue in late 2004, without a prior meeting of the Ad Hoc Committee or the Working Group of the Sixth Committee. (See Annex 1)
The human genome underlies the fundamental unity of all members of the human family, as well as the recognition of their inherent dignity and diversity. Everyone has a right to respect for their dignity and for their rights regardless of their genetic characteristics. That dignity makes it imperative not to reduce individuals to their genetic characteristics and to respect their uniqueness and diversity. “Man is not just any mammal. Animals can be reproduced through cloning. But humans are shaped by education, science and culture. Not by cloning.” (Koichiro Matsuura, Director-General UNESCO).
Given the highly sensitive issues of cultural variety and the important impact of the expected legislation on the heritage of humanity in a symbolic sense, it might be of interest to present to the UN General Assembly meeting in late 2004 a collection of reports reflecting the attitudes expressed by the representatives of different religious and world views.
A worldwide network will link specialists in medical and environmental ethics and other related fields including philosophy, law, decision-making, theology, etc. from a wide array of countries. Participants at the Fifth Asian Bioethics Conference (ABC5/TRT9) which was held 13-16 February 2004 in Tsukuba are the first who have signed up into the network. The project is open to all to join.
In addition to cloning, the interested persons with local experience and experts will contribute reports of approximately 10,000 words on the status and priority areas of bioethics in their respective region. Especially, academics and those already active in practical bioethics projects (e.g. NGOs) from developing countries are sought. The articles will be published and all contributions acknowledged.
On the other hand, new pandemics are threatening entire populations; viral- and sub-viral-induced diseases produce health scares which are difficult to be dealt with even in economically developed countries. However, is biotechnology the answer to world’s most pressing problems, such as hunger and poverty? Or is it rather a matter of resource distribution?
The World Health Organization acknowledges that about 80% of the world’s people still have no access to modern health care services and depend primarily on traditional systems of health care. FAO estimates that one person dies every two seconds of hunger. Access to health care and medicines, clean water, education and the quality of medical interventions are immediate problems affecting lives of more than half the world. It thus appears that (health) education and improvement of doctor/patient relationship are greater priorities than stem cells or genetics.
A significant result of the UNU/IAS project will be the fact that through the established contact points, isolated researchers from developing countries will be supported and integrated in a constructive bioethics network. The generated reports coming from various regions of the world will produce a volume of open access information as a short-term outcome.
At the same time, we are aware of the dilemmas faced by the majority of the planet’s people and consider the humble attention given to traditional medicine on an international and institutional level, including by the World Health Organisation (WHO). It was said already in Alma Ata that “primary health care for all by 2000 cannot be achieved without traditional medicine getting equal recognition as conventional western treatment.”
However, amid the neglect by many governments and health institutions, it is western pharmaceutical companies and universities that are showing greater interest in traditional medicine, with an eye on the potentially huge profits from it in the future.
With the World Trade Organisation push for patent rights it is the patenting of community knowledge that is in danger. Many African universities are doing research in medicinal herbs available in the continent - and western multinational companies are getting increasingly interested in traditional healing methods in Africa. If researchers are not given enough incentives, they could go out with the results.
Due to the neglect of traditional medicine systems by developing-country governments, their people could end up having to pay western companies to use their own traditional medicines in the future. More than 65% of Indian people depend on indigenous medicine. Access to and control of indigenous medicine should be with local communities. Multinational companies, with the collaboration of local officials, are already in the process of patenting knowledge that has been with local people for centuries.
The privatisation of health care has turned medicine away from preventive health care toward an industry of high-tech curative capital-intensive care, where traditional healing systems get a low profile.
Through the established network of traditional medicines practitioners and researchers, together with local and national decision makers, it is our aim to strengthen medical care at the peripheral level and at the same time conduct clinical trials on the respective methods, while giving careful consideration to the sensitive cultural and environmental issues. These activities will benefit the researchers in developing countries, who will publish their results in recognized scientific journals, the traditional practitioners, who will be encouraged to share their knowledge and given information on applicable hygiene and nutrition basics, the suffering people, who will have more confidence in more types of medicine and more options, and ultimately the local and national governments, who will appreciate a reduction of cost through preventive and natural medicine.
The actual situation can be replaced by a win-win situation, where traditional knowledge can be incorporated in practice, without the need for patents, by rendering it to the public domain. Biodiversity and cultural diversity could be more efficiently preserved through regulations and encouragement, rather than the present approach in uniformization in the name of modernization. The loss of habitats and habits can be reduced, contributing to the goal of balancing nature and development.
The research will focus on case studies reflecting approaches to integrate traditional medicines into the national health systems in various countries and at the same time adding to health literacy improvement.
Poverty: With Special Attention To Bioethics
- Shinryo N. Shinagawa, M.D.[.]
Emeritus Professor of Hirosaki University
036-8223 Fujimi-cho 32-3, Hirosaki, JAPAN
E-mail: Fax: 0172-32-8053 Tel: 0172-32-3921
As I was born in a large family, not so rich, experienced the Kanto Great Earthquake of 1923 in Tokyo, the World War II and its miserable sequelae in 1940s, worked as a clinician and a medical teacher in a rural poor district of Northern Japan, and made trips around the world including many developing countries, my concern and experience on poverty is great unusually and probably covers wide fields and topics. This paper is a short summary of my own personal experience and perspective especially from a medical and bioethical viewpoint.
There are a variety of poverty. They are economic, materialistic, social, intellectual, emotional, and philosophical poverties. Although I am of an opinion that the most serious poverty in today’s world is neither economic nor materialistic but emotional and philosophical, now I am discussing only on economic and materialistic poverty.
Classifications of Economic and Materialistic Poverty
Causes of economic and materialistic poverty have been identified in a variety of sources, ranging from an unbalance between natural and human resources to deficiencies in the administration of income support and the injustice of the economic and social system. Economic and materialistic poverty has been classified in many ways. Here, I am introducing three examples of classifications.
The first is a classification of poverty according to dimensions or the width who suffer from. In other words, as seen in Table I, there exist from a personal, individual and case poverty to the world-wide and global poverty.
Table I. A Classification Of Poverty To Width And Dimension
1. Personal, individual and case poverty
2. Familiar or domestic poverty
3. Communal or regional poverty
4. Social class poverty
5. National poverty in developing countries
6. Nations-Group’s, continental or subcontinental poverty
7. World-wide or global poverty
The second is a classification based on reasons of poverty mainly from a medical viewpoint. As seen in Table II, they are hereditary, congenital or acquired, short-term or long-lasting, cycling, cyclical or continuous, avoidable or not, and so on.
Table II. A Classification Of Poverty From Medical Viewpoint
1. Hereditary, congenital and acquired poverty
2. Short-term and long-term poverty
3. Temporary, cyclical and continuous poverty
4. Regional/localized and general/widespread poverty
5. Individual and constitutional poverty
6. Relievable/controllable/amendable and unrelievable/Uncontrollable poverty
7. Avoidable and unavoidable poverty
The third is a classification according to the socio-economic origins. As seen in Table III, topics on Origin of Poverty today most widely discussed are all probably included in this table.
Table III. Origin And/Or Reason Of Poverty