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August 30, 2011 | Posted By David Lemberg, M.S., D.C.

Distributive justice concerns the equitable distribution of scarce resources among all socioeconomic groups and population sectors. The question of distributive justice is a key ethical consideration in all aspects of medical care, including assisted reproductive techniques and reproductive genetics.

Access to cancer pharmaceuticals provides a prime example of violations of distributive justice. These drugs typically cost tens of thousands of dollars a year. Some costs are stratospherically high. In 2009 a new drug, Folotyn, manufactured by Allos Therapeutics, was projected to cost about $30,000 per month.1 Remarkably, Folotyn hadn’t been shown to prolong lives — its effect was to shrink the tumors caused by peripheral T cell lymphoma, a rare disease affecting 5000–6000 Americans each year.

Erbitux, used in the treatment of colon cancer, costs approximately $10,000 per month. Avastin costs almost $100,000 per year when used to treat lung cancer or breast cancer.

Society as a whole bears the burden of these enormous expenditures, reflected in annual increases of 10% or greater in health care insurance premiums. In essence, every taxpayer in the United States is helping to maintain the profit margins of the pharmaceutical companies that impose such high prices.

In terms of distributive justice, cancer medications are simply not available to those who can’t afford them. At costs of $10,000 per month, very few individuals can afford these drugs. Medicare and Medicaid cover prescriptions for Avastin and Erbitux, for example, but copayment costs frequently put such medications out of reach for many. Those who are uninsured, of course, cannot even consider taking on the costs of these cancer therapeutics.

If we are an ethical society, concerns about distributive justice extend to those living beyond our shores. Treatment for HIV/AIDS presents a classical example of ongoing violations of distributive justice. For instance, drugstore.com sells a 90-day supply of Atripla for $5400 ($1800 per month), an inconceivable cost for persons living on less than $2 per day. Although steep discounts are provided by manufacturers for those living in developing nations, even a cost of $1 a day (the price for many generics) is much too high.

To a great extent, the HIV/AIDS pandemic persists owing to the lack of availability of appropriate medication. Global pharmaceutical corporations receive hundreds of billions of dollars in annual revenues. They have the capability of providing medications at a de facto pro bono rate to developing nations. Distributive justice requires they engage in such activities.

1Pollack A: Questioning a $30,000-per-month cancer drug. The New York Times, December 4, 2009

The Alden March Bioethics Institute offers graduate online masters in bioethics programs. For more information on the AMBI master of bioethics online program, please visit the AMBI site.

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BIOETHICS TODAY is the blog of the Alden March Bioethics Institute, presenting topical and timely commentary on issues, trends, and breaking news in the broad arena of bioethics. BIOETHICS TODAY presents interviews, opinion pieces, and ongoing articles on health care policy, end-of-life decision making, emerging issues in genetics and genomics, procreative liberty and reproductive health, ethics in clinical trials, medicine and the media, distributive justice and health care delivery in developing nations, and the intersection of environmental conservation and bioethics.
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