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The Jewish Ethicist: Reasonable Remedy

The Jewish Ethicist: Reasonable Remedy

Is it ethical for medicines to be so expensive?

by

Q. Life saving medicines often cost a fortune even though the production cost is minimal. Is this ethical?

A. The situation you describe is indeed very common. The reason is that drug companies take out patents on these innovative compounds. Thus they have a monopoly for a period of years, enabling them to charge rates way above production cost. The rationale for giving drug makers (and other innovators) such a monopoly is that it will give them a fair incentive to undertake the research and development costs necessary to create new and valuable inventions. Development and particularly testing costs for new medicines are astronomical.

We actually touched on this topic in a tangential way in a previous column on the topic of evicting poor tenants. I want to cite the relevant passage from that column and then elaborate a bit.

While society definitely has an obligation to protect the needy and keep them from being cast into the street, it's neither fair nor practical to expect this obligation, which applies to us all, to be borne solely by the landlords.

At the same time, it won't do for landlords to stubbornly stand on their rights, insisting that the property is theirs and they have the right to decide on the tenants and on the rental. Our Sages, following the Prophets, attributed the destruction of Jerusalem two thousand years ago to the low ethical standards of the residents. In particular, they said, "Jerusalem was destroyed because people insisted on strict justice, and were not willing to compromise." Property owners have to recognize that even if the war against homelessness is not theirs to fight, they are the ones on the front lines of this battle.

Other groups find themselves in a situation similar to yours. Employers cannot be solely responsible for helping the unemployed and drug companies cannot be solely responsible for providing medication to the needy, but they are in the front line. I think that you can learn from some methods used by these groups. For instance, many downsizing employers invest in outplacement services, helping laid-off workers to find new jobs or to acquire new skills. Some drug companies have tried to form alliances with NGO's (non-governmental organizations) who are working to improve medical care for the needy.

The implication is that drugs need to be made available to the needy, but it is unrealistic to place the entire burden on drug companies. At the same time, drug companies should play a leading role in the effort. Let us elaborate the Jewish sources for each stage of this argument.

"Drugs need to be made available to the needy": Providing medicines to sick individual is a mitzvah (commandment). Jewish law states that we should not earn money for carrying out the mitzvot of the Torah (though in general we do not need to incur a loss where the mitzvah is to benefit someone else). For this reason, Jewish law stipulates that it is forbidden to sell vital medicines for unreasonable sums. (1)

The Talmud tells a story of a Roman matron who knew of an effective remedy for a serious disease and tried to keep it secret. The sage Rebbe Yochanan tricked her into disclosing the remedy and made it public; the grave transgression of misleading others had to be put aside in favor of making this vital knowledge available to the public. (2)

"It is unreasonable to place the entire burden on drug companies": Just as it is a commandment to provide medicines to the sick, so it is a mitzvah to provide basic needs to the poor. The Torah tells us that we must provide the needy "enough for the needs which he lacks." Yet this doesn't mean that the first householder which the poor person visits must provide for all of his needs. Rather, writes Rabbi Moshe Isserles in his glosses to the Shulchan Arukh (Code of Jewish Law) "A private individual is not obligated to give the poor person enough for his needs; rather, he should make his distress known to the community" (Shulchan Arukh, Yoreh Deah, 250:1).

Furthermore, our law states that we should not sell medicines for "unreasonable" sums, yet given the vast sums needed for development and testing sometimes a great expense may be considered "reasonable" even though the production costs are minimal.

"Drug companies should play a leading role in the effort": As we just cited, Rabbi Moshe Isserles states that even though the first person faced with the needy individual need not provide all his needs, even so "he should make his distress known to the community". The drug company is the first one called upon to provide the needs of the sick; they have to take a leading responsibility in finding a way for the community as a whole to fulfill the mitzvah of providing medicine for all in a way which is practical and sustainable. Excessive largesse may lead to profits for drug manufacturers at the expense of appropriate availability of medicines; yet trying to squeeze the drug companies for low prices on existing medicines risks choking off incentives for development, thus killing the goose that lays the golden eggs.

A number of financing models fit this general schema. National health plans and HMO's finance drug purchases, but not blindly: they negotiate with the drug companies. As we wrote before, "Some drug companies have tried to form alliances with NGO's (non-governmental organizations) who are working to improve medical care for the needy." A worthy recent initiative is to create a global fund to finance certain AIDS medicines.

I do not believe that a Jewish ethical approach is inherently antagonistic to reasonable patent rights to drug companies. A basic commitment to equity requires society to work to provide adequate medical treatment to all who need it, but the same commitment requires that the cost burden also be equitably distributed.

SOURCES: (1) Shulchan Arukh, Yoreh Deah 336:3 (2) Yoma 84a.

Send your queries about ethics in the workplace to jewishethicist@aish.com

To sponsor a column of the Jewish Ethicist, please click here.

The Jewish Ethicist presents some general principles of Jewish law. For specific questions and direct application, please consult a qualified Rabbi.

The Jewish Ethicist is a joint project of Aish.com and the Business Ethics Center of Jerusalem. To find out more about business ethics and Jewish values for the workplace, visit the JCT Center for Business Ethics website at www.besr.org.

Published: April 9, 2005


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Visitor Comments: 3

(2) Selina, April 12, 2005 12:00 AM

comment on expensive medicine

The bottom line is that medicine is a huge money making BUSINESS and has nothing to do with
whether it is affordable to the average consumer. Consider the fact that before the advent of
"modern medicine" all a person had to do was get a cure or remedy from the forest or hillside. I
have seen many documentaries on ancient civilizations and how they survived medicinally. If
they could perform successful brain surgery then perhaps the old way of procuring medicine
wasn't so bad after all. Case in point: I see many tv ads selling heartburn remedies. If our
stomachs are producing “too much acid” as is the stated cause of acid reflux, then why, oh why,
is it remedied by taking a tablespoon of vinegar at the cost of less than 1 penny per spoon?
Because if the sellers of modern medicine told one that, they couldn’t make any money selling
their PRODUCT, that’s why. Ethical expensive medicine? I think not.

Onsi, August 19, 2012 2:20 PM

Herbs and good foods are the safest way to cure

Our grandmothers, great grandmothers and on back knew of safe natural ways to take care of all our ills. They were not concerned with making a profit they were concerned about our health. I have done a lot of research and have discovered that most drugs do more harm than good. A drug for something like toe nail fungus (which can be cured by soaking your feet in vinegar water and going bare foot) can cause organ damage. Do you really want a drug that causes damage to your body for something as simple as toe nail fungus. I don't get it because I let my feet breathe. Far too many chemical drugs are toxic to our systems, we were never meant to take such substances. And it is all about making a profit at the expense of others. The more I learn about the pharm corporations the worse they look. Do yourself a favor and learn how to grow your remedies in wholistic ways without chemicals and you will heal faster and live a healthier life.

(1) Anonymous, April 12, 2005 12:00 AM

The incentive argument you made is not just theoretical. In Europe, where there is regulation on the amount of money drug companies can charge for their new medicines, many of the big drug companies have closed shop, because the risk/reward ratio was not favorable. The few that still remain are those whose primary sales markets are in non-European countries.

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