Reflections on the Human Condition - Api-fellowships.org

202 SESSION III
cook tasty food, communicate well, teach English to the
children of their wealthy employers for free, and learn
Cantonese almost immediately, is rewarded in many
cases with being treated as a very low-class citizen—not
to mention a back-breaking, full six-day work-week and
a single trip to see the family back home once every two
years.”
Escobar also has the appropriate last word:
Notes
“The Filipinos are a capable, well-educated, joyful
people. Most who have settled abroad, [who have]
escaped the misery of semi-feudal rule and been
given the opportunity to prosper, have done so. But,
of course, they can’t all emigrate or become overseas
workers. Ultimately, they will need to find the
political means to rid themselves of the oppressive
medieval structures that make their lives on Earth
the equivalent of purgatory.”
1 Ha-Joon Chang. 2001. Breaking the Mould: An
Institutionalist Political Economy Alternative to the
Neoliberal Theory of the Market and the State. Social
Policy & Development Program Paper No. 6. Geneva:
UNRISD.
2 Investing in Health, World Development Report, 1993.
Washington, DC: World Bank.
3 UE Reinhardt. 2001. “Can efficiency in health care be
left to the market?”. In Journal of Health Politics, Policy
and Law, 26 (5): 967-992.
4 see for example, EL Hannan, M Racz, TJ Ryan et al. 1997.
“Coronary angioplasty volume-outcome relationships
for hospitals and cardiologists”. In Journal of American
Medical Association 277: 892-898.
5 Suleiman, Abu Bakar; Wong, Swee Lan; Mohan, A. Jai;
et al. 1993. Utilisation of Specialist Medical Manpower.
Report of a collaborative study by the Ministry of
Health and the Academy of Medicine, Malaysia, 1992-
1993.
6 quite apart from economic barriers to existing
treatments, Médecins Sans Frontières (MSF) has
highlighted the persistent problems of neglected
diseases: of the 1,393 new drugs approved between
1975 and 1999, only 16 (or just over 1 percent) were
specifically developed for tropical diseases (such as
malaria, sleeping sickness, Chagas’ disease, kala azar)
and tuberculosis, diseases that account for 11.4 percent
Ref lections on the Human Condition: Change, Conflict and Modernity
The Work of the 2004/2005 API Fellows
of the global disease burden. For 13 out of those 16
drugs, two were modifications of existing medicines,
two were produced for the US military, and five came
from veterinary research. Only four were developed
by commercial pharmaceutical companies specifically
for tropical diseases in humans. These tropical diseases
mainly affect poorer communities in countries of the
South, which do not constitute a valuable enough
market to stimulate adequate R&D by the multinational
pharmaceutical companies. ref: P Trouiller, P Olliaro,
E Torreele, J Orbinski, R Laing, N Ford. 2002. Drug
Development for Neglected Diseases: A Deficient
Market and a Public Health Policy Failure. Lancet 359:
2188-2194 (22 June 2002); R Cohen. 2002. Neglected
Diseases and the Health Burden in Poor Countries.
Multinational Monitor, June 2002; Michael Kremer &
Rachel Glannerster, “Creating a Market for Vaccines”
in New York Times, 1 June 2001.
7 Woolhandler, S and D. Himmelstein. 1999. “When
Money is the Mission: The High Costs of Investor-
Owned Care”. In New England Journal of Medicine
341: 444-446; P Devereaux, P Choi, C Lacchett, et al.
2002. “A systematic review and meta-analysis of studies
comparing mortality rates of private for-profit and
private not-for-profit hospitals”. In Canadian Medical
Association Journal 166: 1399-1406; Woolhandler, S.;
Campbell, T. and Himmelstein, D. 2003. “Costs of
Health Care Administration in the United States and
Canada”. In New England Journal of Medicine 349:768-
775; Donald Light (ed.). 2001. “Comparative Studies
of Competition Policy”. In Social Science and Medicine
52(8), special issue, April 2001; Heller, PS. 1982. “A
Model of the Demand for Medical and Health Services
in Peninsular Malaysia”. In Social Science & Medicine
16: 267-284.
8 see for example William Greider. 1997. One World,
Ready or Not: The Manic Logic of Global Capitalism.
New York: Simon & Schuster; and a critical early
review by Lester Thurow, The Atlantic Monthly, March
1997, disputing the claims of overcapacity.
9 in the terminology of the neo-Keynesian French
Regulation School, this would be an instance of
“regulation failure” and crisis of the existing regime
of accumulation: “there are long periods of time when
things work, when the configuration of social relations
that defines capitalism, for instance, reproduces itself in a
stabilized way. We call such a continuing system a regime
of accumulation. This refers, of course, to economics but this
can be extended to politics, diplomacy, and so on… we have
to think [also] about the ways this regime of accumulation
is achieved… individual expectations and behavior must