In this issue of the Hastings Center Report, Govind Persad and Ezekiel Emanuel argue that “[t]he provision of cheaper, less effective health care is frequently the most effective way of promoting health and realizing the ethical values of utility, equality, and priority to the worst off.” I agree that we should not let the perfect get in the way of the good, but just providing cheaper, less effective treatment for utilitarian or other reasons is not a comprehensive approach to global (...) health. In my experience as an on-the-ground global health practitioner, the choice is never that simple. As time passes, dynamics evolve, and so should the responses to a global health problem. The goal of global health should be urgently improving responses toward better access to care and equity in health, without which the good may become the enemy of the better. In other words, there are places and times in which the approach Persad and Emanuel describe may be appropriate, but their recommendations fail to account for the realities of a population-level medical emergency and for the fact that once an emergency is initially or partially addressed in any setting, time can be the enemy, if it breeds complacency. (shrink)

This article outlines challenges to benefitting developing countries that are hosts of international research. In the context of existing guidance and frameworks for benefit‐sharing, it aims to provoke dialog about socioeconomic factors and other background conditions that influence what constitute benefits in a given host setting, and about the proportionality between benefits to hosts and benefits to sponsors and researchers. It argues that capacity‐building for critical thinking and negotiation in many developing country governments, institutions, and communities is a benefit because (...) it can help to overcome background conditions that impinge on equitable international research negotiations, partnerships, and benefits. Enhancing the capacity for both critical thinking and negotiation can, like other targets of capacity‐building, nurture respectful and trusting partnerships that benefit all stakeholders in international research. (shrink)

Stakeholders in global health, including governments, international and nongovernmental organizations, and corporations, face complex decisions about how to help improve the lives of those most burdened by sickness and disease while upholding their rights and facilitating the transition to a more just social and political order. In “The Case for Resource-Sensitivity: Why It Is Ethical to Provide Cheaper, Less Effective Treatments in Global Health,” Govind Persad and Ezekiel Emanuel argue that “[t]he provision of health care in developing countries should reflect (...) what best balances utility, equality, and priority to the least advantaged in those countries.” This positive proposal faces several difficulties. For one thing, it is not clear that these are the only relevant values, and moreover, even if we assume that they are, we do not know what global health policies these values rule out because conflict between the values is pervasive. (shrink)