Wait, Free Speech Doesn't Cover That?

"It's a potential catastrophe for patients." - Steve Nissen (Head of the Cleveland Clinic)

No, not the zombie-apocalypse that we narrowly missed last Friday, but the possibility of protecting off-label promotion of medical drugs as free speech.

About a week ago, American drug giant Pfizer (proud bringer of Lipitor)  paid the US government more than $55 million in fines for the actions of one of its companies, Wyeth, which overstated the benefits of its drug protonix, despite warnings from the FDA.

While drug companies paying for similar offences is an age-old story, a recent court ruling could deeply reduce the trust we have maintained with drug companies. According to US vs. Caronia, it was initially ruled that the defending company (Jazz Pharmaceuticals) was over exaggerating the benefits of its drug Xyrem, and thus had to pay the fines. However, a federal appeals court has overturned that statement, saying "that off-label promotion should be protected as free speech." The case will proceed to the Supreme Court, meanwhile, what will it mean for us if off-label promotion does indeed become protected?

Well, two things.

1. Loss of trust between patients and drug companies (if there was any to begin with)
2. Discourage "good science"

By allowing drug companies to have unrestricted promotion of off-label uses, our job as consumers becomes that much harder. We have to begin analyzing which uses and side effects to truly take into account, or whether they should be taken into account. Allowing off-label promotion will not only affect the way we buy drugs, but also the way we approach drug companies. Is it really necessary to add suspicion to an already uneasy relationship?

According to the journal Nature, forcing drug companies to go through the FDA-approving process encourages companies to invest in trials in order to provide truth to their off-label uses. Trying to turn off-label uses to label uses, progresses Science and Medicine development. For example, through the trials Johnson & Johnson was able to expand its drug label, for patients who have advanced prostate cancer.

Good habits lead to good science, something we can't avoid losing so that drug companies can simply make more money.

Pardon My French... or My Asian?

                       
Would you categorize either as "Oriental?"

When Lady Gaga's "Born This Way" overtook the charts on May of 2011, it wasn't the expression of creativity that shocked the audience, but her overt use of the word, "Orient."

Defined by Merriam Webster,
Oriental: sometimes offensive : Asian; especially : one who is a native of east Asia or is of east Asian descent.

So, why is it so offensive to use this word against people like, say me? And in fact it is considered so offensive that in the states of Washington and New York, the word "Oriental" was banned from all legislature. Jeff Yang explores this age old question in an NPR article.

To be quite honest, the word "oriental" actually isn't a slur (believe me, there are worse things you could be called), but it's offensive because it is more indicative of the time period.

Oriental was predominantly used in the early 20th century, a time associated with the subordinate status of Asians, from exoticism to the old stereotypical geishas. Professor Wu states that the word "oriental is like the word negro. It conjures up an era." It brings up the 1952 Asian exclusion acts, racism that prohibited Asian immigrants from attaining citizenship. As a result, the word "Oriental" is considered racist. Using the word implies the same thoughts and opinions felt during the mid-1900s.

At the same time, the word, according to Jeff Yang, is just inaccurate. "Orient" translates to just "the East," and that term for the Asian region is incomplete for two reasons. First, only in a flat world does it truly make sense to be calling the Asian region the "Far East" because in the context of our spherical world, if you keep going east, it eventually becomes the west. In other words? It's really outdated. Second, "Oriental" also effectively leaves out completely the Indian subcontinent, whereas, the term "Asian" includes the Indian subcontinent. Therefore, the term "Oriental" is not only inaccurate but also ignorant of current times and geography.

So, while Lady Gaga was just trying to prove the necessity of being our own individuals, maybe next time she can prove the necessity of being politically correct individuals.

How neutral is neutral?

Reading Reading Lolita in Tehran, I was introduced to the complex world of wearing veils in the Muslim culture. Naturally, the controversial issue of its ban in countries such as France and Belgium came up. I asked myself, "How does a country go about expressing a ban on a religious veil neutrally?" So, I went on a quest to answer this question...

As I looked at the different cases for the burqa ban, I noticed two things:
1. Absence of any "signal" words - veil, muslim, etc.
2. Playing the Hero

An article analyzing the 5 arguments of the French burqa ban legislation, claimed that, as was expected, the words, "women, veil, Muslim, or even burqa" were never mentioned in the entire bill. Instead, it was phrased as prohibiting:

"porter une tenue detinee a dissimuler son visage" ("wearing attire designed to hide the face")

While this shows neutrality in the law, there were a slew of exceptions that followed:

"The prohibition described in Article 1 does not apply if the attire is prescribed or authorized by legislative or regulatory dispensation, if it is justified for reasons of health or professional motives, or if it is adopted in the context of athletic practices, festivals, or artistic or traditional performances."

These exceptions indicate the subtle bias within the legislation, and perhaps even a favoritism to Christianity. In fact, the French's main response to the legislation is that they have a similar "dress code" for other religions too, a ban on the Jewish yarmulke and large Christian crosses. Yes, Christian crosses. The main difference is that the yarmulke and the headscarf are both religious obligations, whereas the Christian cross is not an obligation.

However, what was most appealing about the analysis, was the presence of the idea of "imprisonment" in the bill. The idea of imprisonment was portrayed through the bill's explanation of the coercion that the women are put through to wear the veil as well as the suffocating aspects of the veil. For example, the veil was described as a "degrading prison" by one of the legislators, as it objectifies women. At the same time, because the veil covers the entire body, it's seen as hot and uncomfortable, and therefore a health hazard.

By taking a deeper look at the bill's efforts to "free" the women, we see both a superficial understanding of the religion and an attempt to play the hero role in a situation where a hero wasn't called for. But, I'll leave that for you to judge. How neutral is such a ban? What does it reveal about a country?

A Trapped Democratic Republic of Congo

In recent light of events involving the M23 in the Democratic Republic of Congo, let's take a deeper look at the effect of the 4 traps described by Paul Collier in the Bottom Billion.

The Conflict Trap:

Among the slew of nicknames that the DRC has, "conflict" ought to be one of them. Collier defines the two greatest risk factors for those that fall under this trap are low income and low growth. With a stagnant and slowly declining growth rate of approximately 6% and nearly 70% of the population in poverty, the DRC has had a civil war under Kabila. Yet, the root cause of the conflict in the DRC goes back to the Berlin Conference of 1884. Unaware, the European nations largely combined some Rwandan speaking population along Northern Kivu and Southern Kivu with Congolese populations. For example, the Banyarwanda (aka "those who come from Rwanda"), populate much of North and South Kivu. While, they live in the DRC, they speak the language of Rwandans, and thus with the lack of even good governance, the area is constantly mired in conflict. Language can play the important role in unifying a country and tearing it apart.

At the same time, this internal conflict fuels the conflict coming from the outside. The M23 rebel group provides ample evidence of this. Because of the internal divisions spawned by the linguistic and ethnic differences, allows the M23 rebel group to even set up de facto administration within the DRC and to overtake Goma and Sake.

But let's take a closer look at the role of having Rwanda as a neighbor...

The Landlocked with Bad Neighbors Trap:

While Collier defines this particular trap with the characteristics of being fully surrounded by other countries, the DRC partially falls under this trap. The DRC, although it appears to be at the heart of Africa, actually has approximately 40 km coastline. For example, it has access to trade, to export one of its main natural resources, its mining industry. However, just because it's not landlocked, doesn't mean it avoided the bad neighbors.

History shows that not even 20 years ago, because of the DRC's greedy neighbors, Uganda and Rwanda, the country struggled in a great civil war. And most recently, the M23 rebel group infiltrated the DRC, capturing Goma and Sake, reviving the bad blood among the Ugandans, Rwandans, and Congolese. After all, the M23 is largely found to be heavily supported by the Rwandans and possibly Ugandans.

Yet, why the Congo is deeply affected by its neighbors relates back to not only the aforementioned language issue, but it's a case of bad governance makes the situation worse. As Collier states, " a good government can most surely make a difference in a landlocked resource-scarce country, even with bad neighbors" (63).

Bringing us to...  

The Bad Governance Trap:

The DRC hovers the boundary of falling under this trap. It hovers because it hovers the boundary of being a failed state and not being a failed state. A failed state, is based on the parameters of bad governance and bad policies, according to Collier. So, remember Moise Tshombe or Mobutu? People who antagonized ethnic groups by supporting regional strong men who plunder resources. These figures created the DRC's past as a failed state. In this sense, the DRC is a paradox. While the current president, Kabila has implemented budgeting programming, it lacks in its ability to stop figures like Bosco Ntaganda (aka the general of the Congolese army).

Further evidence of bad governance points to the humanitarian crisis that remains uncontrollable by the government. With nearly, 1.8 million women raped, at a rate of approximately 1 rape per minute. Rapes committed primarily by unpaid government soldiers. The inability to stop the humanitarian crisis, leaves the population largely behind, especially since this then affects education. Although Collier mentions that a precondition for a turnaround necessitates a large enough population so that the educated population reaches critical mass. However, in the case of the Congo, if such a large portion of the population is oppressed, education becomes second to survival, and thus, the bad governance trap remains.

The Hall of Fame - DRC's leaders over the years

Kasavubu

Mobutu

Laurent Kabila

Joseph Kabila

The Natural Resources Trap:

The DRC unfortunately also has a case of the Dutch Disease. Although it is blessed with precious resources such as cobalt, copper, diamonds, gold, zinc, etc, it has known exploitation and corruption as a result of these resources. In fact, The Heart of Darkness delineates the Dutch Disease and its effects on the DRC. The DRC's particular case of Dutch Disease comes with two implications. The first is the humanitarian crisis that it has spurred. In terms of the value of human life in the DRC, it is worth very little. The armies and proxy militias of nearly 6 different countries as well as those of the Congolese government and rebel groups have taken no shame in plundering and looting the natural resources of the DRC.

The second implication is that of Collier's: using natural resources to fuel conflict, especially since the DRC is democratic while it is also very ethnically diverse. In fact, the mining industry of the DRC is evidence of corruption and exploitation. For example, many "makeshift" mining ores are built to exploit these resources, and many during the wars affecting North and South Kivu, creating the profit to buy more arms for the militias. This in effect prohibits further growth, as the country is put under the conflict trap as well.