This document summarizes 25 facts about the hidden history of medicine. Fact #3 discusses how the FDA suppressed a natural cure for cancer discovered by Dr. Stanislaw Burzynski for over 30 years. Burzynski found that a combination of phenylacetate and phenylacetyl-glutamine could cure cancer, including terminal cancers. However, the FDA, medical boards, and pharmaceutical industry persecuted Burzynski and seized over 12,000 of his patient records. They suppressed his cure to protect the lucrative cancer industry. Burzynski eventually won court cases showing his treatment worked, but the FDA continued harassing him for years in a campaign to shut down his natural cure.
Evangeline Chee - China and India making inroads in Biotech Drugscynrx
1) Chinese and Indian drug makers are on the verge of selling cheaper copies of complex biotech drugs to treat diseases like cancer, diabetes, and arthritis that are currently only affordable in rich nations.
2) This could transform healthcare in much of the world but spark backlash from major pharmaceutical companies and rich countries seeking to protect drug patents.
3) Advocates argue these copycat drugs could increase access to life-saving treatments, while others argue ensuring drug company profits is needed to drive innovation.
Knowledge of the Implementation of the Malaria Control Program in Four Health...YogeshIJTSRD
This document summarizes a study on healthcare providers' knowledge of malaria control programs in four health districts in Yaounde, Cameroon. The study involved surveying 42 healthcare providers who received training and 50 providers who did not, across the districts. It found that trained providers generally demonstrated good knowledge of malaria diagnosis, treatment and prevention, with higher percentages than untrained providers. However, not all practices followed national guidelines. The study concluded there was room for improvement in fully implementing recommended case management procedures.
The global food supply is being compromised by large corporations prioritizing profits over safety and quality. Trade agreements like NAFTA allow corporate profits to take precedence over protective laws, threatening public health. Major hazards include disease from antibiotic and hormone use on factory farms, which process most of the US food supply. Lobbyists also undermine laws to protect consumers through trade deals. Inadequate transportation and distribution systems further endanger the food supply. To protect lives, consumers must educate themselves and demand safer, more sustainable food practices.
Network of corruption the cdc who and big pharmaKaye Beach
Unfortunately it is very profitable for the drug industry to get the medical profession to promote vaccines to the general population. Drug companies are corporations and they do not have a duty to "do no harm". Their only duty is to make money and "mitigate" any liability the company might be forced to deal with in a court of law. It is important the public doesn't forget this as it is very unlikely your physician or anyone who works for public health will remind you of this reality.
Here are the major signs of government and/or medical industry corruption:
1. Fraud and/or Misrepresentation
2. Conflict of interest
3. Bribery
4. Lack of transparency (concealment or deception)
Malaria Control & the RTS,S Vaccine-under-trial: Matters Arising by Dr. IdokokoAbraham Idokoko
The document discusses malaria control and the RTS,S vaccine currently under trial. It provides an overview of the global malaria situation, the situation in sub-Saharan Africa and Nigeria specifically. It outlines the key components of malaria control including case management, vector control methods, and monitoring and evaluation. Progress made in malaria control from 2000-2011 is highlighted, along with current challenges such as funding shortages and insecticide and drug resistance. The development of malaria vaccines including the RTS,S vaccine currently undergoing trials is also discussed.
KCR features in the newest Pharma Voice, June 2017, top industry publication. Andrzej Piotrowski, MD, Ph.D., Medical Monitor at KCR, commented on malaria treatment and research.
This document discusses the emergence and spread of the New Delhi metallo-beta-lactamase 1 (NDM-1) gene, which confers resistance to nearly all beta-lactam antibiotics. It notes that NDM-1 was first identified in India in 2010 and has since spread globally through travel and economic activity. The authors argue that inadequate sanitation in India has allowed NDM-1 to spread widely among the population. They call for a global political response to antibiotic resistance, including increased funding for surveillance programs, accountability measures for antibiotic stewardship, and economic incentives for developing new antibiotics.
This document summarizes 25 facts about the hidden history of medicine. Fact #3 discusses how the FDA suppressed a natural cure for cancer discovered by Dr. Stanislaw Burzynski for over 30 years. Burzynski found that a combination of phenylacetate and phenylacetyl-glutamine could cure cancer, including terminal cancers. However, the FDA, medical boards, and pharmaceutical industry persecuted Burzynski and seized over 12,000 of his patient records. They suppressed his cure to protect the lucrative cancer industry. Burzynski eventually won court cases showing his treatment worked, but the FDA continued harassing him for years in a campaign to shut down his natural cure.
Evangeline Chee - China and India making inroads in Biotech Drugscynrx
1) Chinese and Indian drug makers are on the verge of selling cheaper copies of complex biotech drugs to treat diseases like cancer, diabetes, and arthritis that are currently only affordable in rich nations.
2) This could transform healthcare in much of the world but spark backlash from major pharmaceutical companies and rich countries seeking to protect drug patents.
3) Advocates argue these copycat drugs could increase access to life-saving treatments, while others argue ensuring drug company profits is needed to drive innovation.
Knowledge of the Implementation of the Malaria Control Program in Four Health...YogeshIJTSRD
This document summarizes a study on healthcare providers' knowledge of malaria control programs in four health districts in Yaounde, Cameroon. The study involved surveying 42 healthcare providers who received training and 50 providers who did not, across the districts. It found that trained providers generally demonstrated good knowledge of malaria diagnosis, treatment and prevention, with higher percentages than untrained providers. However, not all practices followed national guidelines. The study concluded there was room for improvement in fully implementing recommended case management procedures.
The global food supply is being compromised by large corporations prioritizing profits over safety and quality. Trade agreements like NAFTA allow corporate profits to take precedence over protective laws, threatening public health. Major hazards include disease from antibiotic and hormone use on factory farms, which process most of the US food supply. Lobbyists also undermine laws to protect consumers through trade deals. Inadequate transportation and distribution systems further endanger the food supply. To protect lives, consumers must educate themselves and demand safer, more sustainable food practices.
Network of corruption the cdc who and big pharmaKaye Beach
Unfortunately it is very profitable for the drug industry to get the medical profession to promote vaccines to the general population. Drug companies are corporations and they do not have a duty to "do no harm". Their only duty is to make money and "mitigate" any liability the company might be forced to deal with in a court of law. It is important the public doesn't forget this as it is very unlikely your physician or anyone who works for public health will remind you of this reality.
Here are the major signs of government and/or medical industry corruption:
1. Fraud and/or Misrepresentation
2. Conflict of interest
3. Bribery
4. Lack of transparency (concealment or deception)
Malaria Control & the RTS,S Vaccine-under-trial: Matters Arising by Dr. IdokokoAbraham Idokoko
The document discusses malaria control and the RTS,S vaccine currently under trial. It provides an overview of the global malaria situation, the situation in sub-Saharan Africa and Nigeria specifically. It outlines the key components of malaria control including case management, vector control methods, and monitoring and evaluation. Progress made in malaria control from 2000-2011 is highlighted, along with current challenges such as funding shortages and insecticide and drug resistance. The development of malaria vaccines including the RTS,S vaccine currently undergoing trials is also discussed.
KCR features in the newest Pharma Voice, June 2017, top industry publication. Andrzej Piotrowski, MD, Ph.D., Medical Monitor at KCR, commented on malaria treatment and research.
This document discusses the emergence and spread of the New Delhi metallo-beta-lactamase 1 (NDM-1) gene, which confers resistance to nearly all beta-lactam antibiotics. It notes that NDM-1 was first identified in India in 2010 and has since spread globally through travel and economic activity. The authors argue that inadequate sanitation in India has allowed NDM-1 to spread widely among the population. They call for a global political response to antibiotic resistance, including increased funding for surveillance programs, accountability measures for antibiotic stewardship, and economic incentives for developing new antibiotics.
Brief Overview of Global and Regional HPAI Situation 2011Tata Naipospos
The document provides an overview of the global and regional situation of highly pathogenic avian influenza (HPAI) H5N1. It discusses how the virus has been circulating in poultry and wild birds in Asia, Africa, Europe and the Middle East since 2003. While some countries have regained HPAI-free status, the virus remains endemic in poultry in 5 countries and there are still sporadic outbreaks occurring. Human cases also continue to occur sporadically wherever the virus is present in poultry. The majority of poultry outbreaks and human cases have been concentrated in a few Southeast Asian countries. Live bird markets and cross-border trade are risk factors contributing to the virus's persistence in
This document reports evidence that millions have died from the COVID-19 vaccines worldwide based on analyses of various data sources. It claims that official numbers vastly underreport deaths and side effects. Whistleblowers allege the US death count is 5-10 times higher than reported. Experts warn the vaccines may be causing the greatest risk of genocide in history and call for an end to the programs. However, the conclusions are disputed and rely on uncertain interpretations of limited data.
The document discusses psoriasis, a chronic skin condition affecting over 125 million people worldwide. Psoriasis causes thickened, red, scaly skin patches that often itch and bleed. It can also cause joint pain and increase risks for other health issues. The document outlines pharmaceutical company efforts to develop new drug treatments for psoriasis, including topical treatments, biologics, and oral medications currently in clinical trials. It emphasizes the need for comprehensive care that coordinates treatment from specialists and considers patients' needs to best manage psoriasis as a chronic condition.
Growing evidence suggests that asymptomatic cases could account for 20-50% of total COVID-19 cases and 10-60% of virus transmission. While the risk of catching the virus from completely asymptomatic individuals is low, many people experience only mild symptoms in the early stages of disease and can still spread the virus. This underscores the need for continued strict social distancing even as testing capabilities expand to better track asymptomatic cases and their role in transmission.
Antimalarial metabolization: what have we learnt so far?Premier Publishers
Considering malaria is a highly devastating disease of mankind, total eradication of malaria seems to be an uphill task, the only relief from this disease is achieved by usage of antimalarial drugs. Since malaria is associated with humans from time immemorial, usage of traditional substances to most presently effective antimalarial have been recorded to cure this disease. With the advent of modern biological techniques aided the understanding of the biochemical pathways of antimalarial metabolism thereby helping in designing successful usage of many antimalarials. Nevertheless, improper usages of certain drugs have led to the origin and spread of drug resistant malaria parasites (chloroquine resistant Plasmodium falciparum). Also, the genetic basis of antimalarial metabolism in humans is now well understood and frequent mutations in genes of malarial parasites are well associated with drug resistance. The entire scenario of antimalarial usage in the field have become complicated, partly due to poor understanding between antimalarial metabolism in humans and drug fighting mechanism in parasites, by which resistance to even combined therapy (e.g. Artemisinin Combination Therapy) have started emerging. Vital basic understanding from human and parasite population genetics (involving antimalarial both metabolizing genes in human and resistant genes in parasite) could be an ideal starting point to malaria control.
A single low-cost 2.5mg dose of vitamin D was found to boost the immune system's ability to fight tuberculosis (TB) for at least 6 weeks in a randomized controlled trial. Over 90% of TB patients studied in London hospitals had vitamin D deficiency. While vitamin D supplements were commonly used to treat TB before antibiotics, this is the first study to show that vitamin D supplementation can enhance immunity against mycobacteria that cause TB. A single large dose of vitamin D was found to enhance immunity at low cost and with no safety risks, suggesting vitamin D supplements could significantly impact people most at risk for TB.
This document provides an updated action plan for global COVID-19 vaccination from The Rockefeller Foundation. It summarizes the current unequal distribution of vaccines, with only a small percentage of people in Africa, Asia, and South America receiving doses compared to half in North America and a quarter in Europe. The plan calls for wealthy countries to share more of their surplus vaccine doses sooner to help address this inequity. It also recommends accelerating support for vaccine delivery systems in developing countries, closing the $18.5 billion funding gap for the ACT-A initiative including the $9.3 billion needed for COVAX, and establishing vaccine production capacity in Africa, Asia, and South America to ensure equitable access to vaccines and prepare for future pandem
High prevalence of DR-TB (drug-resistant tuberculosis): An Indicator of publi...Madiha Mushtaque
Tuberculosis (TB) is among the 10 most common worldwide causes of mortality. In Pakistan, estimated 510,000 tuberculosis patients had been diagnosed with an occurrence of 276/100,000. As per most recent global TB report 2018, Pakistan is amongst the 30 countries high TB with drug-resistant Mycobacterium tuberculosis particularly MDR (multi-drug resistant strains). A retrospective study had been designed using DR-TB patients’ records from January 2013 to the December 2017 year from a public sector hospital in Karachi. Overall 315 drug-resistant tuberculosis patient’s data had been incorporated in the study. All data had been analyzed using SPSS version 16 software. Chi-square test had been used to analyze the data with CI (confidence interval) 95% and level of significance 5%. The study result showed that 64.1% MDR patients, 27.9% MTB rifampicin resistance, 4.8% mono-drug resistant , XDR(1.6%), 1% poly-drug resistant and only 0.6% are MDR suspects showing no association of DR-TB with gender (p-value 0.787), age group (p-value 0.757), treatment outcomes (p-value 0.549), year of registration( p-value 0.206), first line treatment history(p-value 0.643) with a 95% confidence interval. The drug resistance TB cases have been periodically rising every year. Early identification is required to reduce the percent mortality and inhibit the disease transmission.
The AIDS epidemic in developing countries has had devastating social and economic impacts. Over 95% of those infected live in developing nations, where AIDS-related deaths are mostly young adults, depriving societies of productive members. In Africa, 4 of 5 HIV-positive women and 87% of infected children live there. By 2004, AIDS had killed over 20 million people worldwide and causes 8,000 daily deaths. Countries like Uganda and Kenya have tried different approaches to curb the epidemic, but it remains a severe crisis, overwhelming healthcare systems and contributing to issues like food insecurity. Access to antiretroviral drugs is limited by their high costs, though treatment has potential to slow the pandemic.
Dr. Lindsey Holmstrom - Feral Swine and Foreign and Emerging Animal DiseasesJohn Blue
Feral Swine and Foreign and Emerging Animal Diseases - Dr. Lindsey Holmstrom; Diagnostic Epidemiologist, Center for Foreign Animal and Zoonotic Center, from the 2013 NIAA Merging Values and Technology conference, April 15-17, 2013, Louisville, KY, USA.
More presentations at http://www.trufflemedia.com/agmedia/conference/2013-niaa-merging-values-and-technology
1) Cancer causes more deaths globally than tuberculosis, malaria and AIDS combined, with 8.2 million, 1.5 million and 1.2 million deaths respectively from those diseases compared to over 8 million cancer deaths in 2012.
2) Approximately half of all new cancer cases occur in Asia, Africa and Latin America, where 44 developing countries have no access to radiotherapy treatment.
3) A $1 investment in radiotherapy yields a $4 return in terms of lives saved and health care costs avoided, showing it is a cost-effective intervention.
Dr. Robert Tauxe - Antimicrobial Resistance and The Human-Animal Interface: T...John Blue
Antimicrobial Resistance and The Human-Animal Interface: The Public Health Concerns - Dr. Robert Tauxe, Deputy Director, Division of Foodborne, Waterborne and Environmental Diseases, US Centers for Disease Control and Prevention, from the 2014 NIAA Symposium on Antibiotics Use and Resistance: Moving Forward Through Shared Stewardship, November 12-14, 2014, Atlanta, Georgia, USA.
More presentations at http://www.swinecast.com/2014-niaa-antibiotics-moving-forward-through-shared-stewardship
The Role of Live Animal Markets in the US and Abroad in the Spread of Zoonoti...JosephGiambrone5
This document discusses the history and spread of avian influenza viruses, including highly pathogenic H5N1, among birds and humans in Southeast Asia since the early 2000s. It notes the first reported outbreaks in birds in 2003-2004 across eight Asian countries and the first reported human cases in Vietnam in 2003. The viruses have continued spreading among birds in the region. It also discusses live bird markets as a source of transmission to humans and notes they have not yet been a source of zoonotic disease transmission in the US. The role of the World Organization for Animal Health in disease surveillance and reporting is highlighted.
The document discusses current transboundary animal diseases (TADs) in the Asia-Pacific region from the perspective of the World Organisation for Animal Health (OIE). It identifies the top 5 priority TADs as foot and mouth disease, highly pathogenic avian influenza, classical swine fever, peste des petits ruminants, and rabies. For each disease, it provides maps showing global and regional distribution and trends over time in the percentage of countries reporting the disease as present or absent. It also discusses OIE standards, reporting systems, and role in facilitating safe international trade in animals and animal products.
COVID-19 is certainly a newly emerged zoonosis, not yet understood properly thus cases need utmost care in its handling in both in human and animals.
More observations and studies can only elucidate the origin, intermediate host and definitive host (till date humans) and maintenance host of SARS CoV-2.
For control of emerging and re-emerging zoonoses potentiating one health environmental approach for understanding disease drivers and control strategies are essential elements.
The Role of Live Animal Markets in the US and Abroad in the Spread of Zoonoti...JosephGiambrone5
Live animal markets have contributed to the spread of zoonotic diseases like avian influenza and coronaviruses. In Southeast Asia, these markets often mix domestic and wild species in unsanitary conditions, allowing viruses to jump between animal hosts and potentially to humans. The first cases of SARS, MERS, and COVID-19 have all been linked to exposure at live animal markets in China, where bats and other wild animals infected domestic livestock. By contrast, live animal markets in the US have strict controls to prevent the introduction of exotic species and do not associate with disease emergence, as animals come from registered sources and are of single species. Uncontrolled live animal markets will continue enabling zoonotic viruses to spillover to humans
This document summarizes Dr. Leslie Ramsammy's concerns about candidates in the 2016 US presidential election linking vaccines to autism and proposing to limit vaccine use without scientific evidence. As a former health minister, Dr. Ramsammy insists that vaccines have significantly reduced child mortality worldwide and calls out Donald Trump, Ben Carson, and Rand Paul for their irresponsible anti-vaccine positions. He is disappointed that prominent health organizations have not more forcefully dismissed these claims and urges taking a public stance to correct misleading statements that endanger children's lives.
Parasitic worms may hold key to cutting spread of hiv researchersBladimir Viloria
Researchers have found that a parasitic worm called schistosomiasis, which infects over 250 million people in developing nations, may be contributing to the spread of HIV. The worms can cause lesions when they lay eggs in women's genital areas, making women three times more likely to contract HIV. Treating the parasitic worm could help reduce HIV transmission, as the drug is inexpensive and donated by the WHO. Additionally, men infected with the worms had HIV viral loads in their semen 10 times higher than uninfected men, but levels returned to normal after treatment. Experts believe addressing this neglected risk factor could significantly help in fighting the HIV epidemic.
This document discusses differences in the spread patterns of various respiratory viruses, including COVID-19, coronaviruses, smallpox, and influenza. It notes that virus size plays a role, with smallpox being larger and spreading mainly through direct contact and droplets, while coronaviruses can spread through airborne transmission as well. Maps and data on outbreaks show that while smallpox took years to spread, COVID-19 increased rapidly in some areas within weeks, indicating differences in transmission. The size of viruses like SARS and influenza fall between smallpox and coronaviruses.
Analysis of H5N1 Influenza Data in Indonesia and the Needs for Improvement - ...Tata Naipospos
Indonesia has experienced widespread H5N1 avian influenza in poultry and 100 human cases. The virus is endemic in birds across 31 of 33 provinces. Three distinct viral sublineages circulate in different regions of Indonesia. Analysis of viral genetics shows the virus spread across the archipelago along trade routes and evolved distinct regional groups. Improved control of poultry movement and vaccination are needed to reduce virus spread and environmental load.
Brief Overview of Global and Regional HPAI Situation 2011Tata Naipospos
The document provides an overview of the global and regional situation of highly pathogenic avian influenza (HPAI) H5N1. It discusses how the virus has been circulating in poultry and wild birds in Asia, Africa, Europe and the Middle East since 2003. While some countries have regained HPAI-free status, the virus remains endemic in poultry in 5 countries and there are still sporadic outbreaks occurring. Human cases also continue to occur sporadically wherever the virus is present in poultry. The majority of poultry outbreaks and human cases have been concentrated in a few Southeast Asian countries. Live bird markets and cross-border trade are risk factors contributing to the virus's persistence in
This document reports evidence that millions have died from the COVID-19 vaccines worldwide based on analyses of various data sources. It claims that official numbers vastly underreport deaths and side effects. Whistleblowers allege the US death count is 5-10 times higher than reported. Experts warn the vaccines may be causing the greatest risk of genocide in history and call for an end to the programs. However, the conclusions are disputed and rely on uncertain interpretations of limited data.
The document discusses psoriasis, a chronic skin condition affecting over 125 million people worldwide. Psoriasis causes thickened, red, scaly skin patches that often itch and bleed. It can also cause joint pain and increase risks for other health issues. The document outlines pharmaceutical company efforts to develop new drug treatments for psoriasis, including topical treatments, biologics, and oral medications currently in clinical trials. It emphasizes the need for comprehensive care that coordinates treatment from specialists and considers patients' needs to best manage psoriasis as a chronic condition.
Growing evidence suggests that asymptomatic cases could account for 20-50% of total COVID-19 cases and 10-60% of virus transmission. While the risk of catching the virus from completely asymptomatic individuals is low, many people experience only mild symptoms in the early stages of disease and can still spread the virus. This underscores the need for continued strict social distancing even as testing capabilities expand to better track asymptomatic cases and their role in transmission.
Antimalarial metabolization: what have we learnt so far?Premier Publishers
Considering malaria is a highly devastating disease of mankind, total eradication of malaria seems to be an uphill task, the only relief from this disease is achieved by usage of antimalarial drugs. Since malaria is associated with humans from time immemorial, usage of traditional substances to most presently effective antimalarial have been recorded to cure this disease. With the advent of modern biological techniques aided the understanding of the biochemical pathways of antimalarial metabolism thereby helping in designing successful usage of many antimalarials. Nevertheless, improper usages of certain drugs have led to the origin and spread of drug resistant malaria parasites (chloroquine resistant Plasmodium falciparum). Also, the genetic basis of antimalarial metabolism in humans is now well understood and frequent mutations in genes of malarial parasites are well associated with drug resistance. The entire scenario of antimalarial usage in the field have become complicated, partly due to poor understanding between antimalarial metabolism in humans and drug fighting mechanism in parasites, by which resistance to even combined therapy (e.g. Artemisinin Combination Therapy) have started emerging. Vital basic understanding from human and parasite population genetics (involving antimalarial both metabolizing genes in human and resistant genes in parasite) could be an ideal starting point to malaria control.
A single low-cost 2.5mg dose of vitamin D was found to boost the immune system's ability to fight tuberculosis (TB) for at least 6 weeks in a randomized controlled trial. Over 90% of TB patients studied in London hospitals had vitamin D deficiency. While vitamin D supplements were commonly used to treat TB before antibiotics, this is the first study to show that vitamin D supplementation can enhance immunity against mycobacteria that cause TB. A single large dose of vitamin D was found to enhance immunity at low cost and with no safety risks, suggesting vitamin D supplements could significantly impact people most at risk for TB.
This document provides an updated action plan for global COVID-19 vaccination from The Rockefeller Foundation. It summarizes the current unequal distribution of vaccines, with only a small percentage of people in Africa, Asia, and South America receiving doses compared to half in North America and a quarter in Europe. The plan calls for wealthy countries to share more of their surplus vaccine doses sooner to help address this inequity. It also recommends accelerating support for vaccine delivery systems in developing countries, closing the $18.5 billion funding gap for the ACT-A initiative including the $9.3 billion needed for COVAX, and establishing vaccine production capacity in Africa, Asia, and South America to ensure equitable access to vaccines and prepare for future pandem
High prevalence of DR-TB (drug-resistant tuberculosis): An Indicator of publi...Madiha Mushtaque
Tuberculosis (TB) is among the 10 most common worldwide causes of mortality. In Pakistan, estimated 510,000 tuberculosis patients had been diagnosed with an occurrence of 276/100,000. As per most recent global TB report 2018, Pakistan is amongst the 30 countries high TB with drug-resistant Mycobacterium tuberculosis particularly MDR (multi-drug resistant strains). A retrospective study had been designed using DR-TB patients’ records from January 2013 to the December 2017 year from a public sector hospital in Karachi. Overall 315 drug-resistant tuberculosis patient’s data had been incorporated in the study. All data had been analyzed using SPSS version 16 software. Chi-square test had been used to analyze the data with CI (confidence interval) 95% and level of significance 5%. The study result showed that 64.1% MDR patients, 27.9% MTB rifampicin resistance, 4.8% mono-drug resistant , XDR(1.6%), 1% poly-drug resistant and only 0.6% are MDR suspects showing no association of DR-TB with gender (p-value 0.787), age group (p-value 0.757), treatment outcomes (p-value 0.549), year of registration( p-value 0.206), first line treatment history(p-value 0.643) with a 95% confidence interval. The drug resistance TB cases have been periodically rising every year. Early identification is required to reduce the percent mortality and inhibit the disease transmission.
The AIDS epidemic in developing countries has had devastating social and economic impacts. Over 95% of those infected live in developing nations, where AIDS-related deaths are mostly young adults, depriving societies of productive members. In Africa, 4 of 5 HIV-positive women and 87% of infected children live there. By 2004, AIDS had killed over 20 million people worldwide and causes 8,000 daily deaths. Countries like Uganda and Kenya have tried different approaches to curb the epidemic, but it remains a severe crisis, overwhelming healthcare systems and contributing to issues like food insecurity. Access to antiretroviral drugs is limited by their high costs, though treatment has potential to slow the pandemic.
Dr. Lindsey Holmstrom - Feral Swine and Foreign and Emerging Animal DiseasesJohn Blue
Feral Swine and Foreign and Emerging Animal Diseases - Dr. Lindsey Holmstrom; Diagnostic Epidemiologist, Center for Foreign Animal and Zoonotic Center, from the 2013 NIAA Merging Values and Technology conference, April 15-17, 2013, Louisville, KY, USA.
More presentations at http://www.trufflemedia.com/agmedia/conference/2013-niaa-merging-values-and-technology
1) Cancer causes more deaths globally than tuberculosis, malaria and AIDS combined, with 8.2 million, 1.5 million and 1.2 million deaths respectively from those diseases compared to over 8 million cancer deaths in 2012.
2) Approximately half of all new cancer cases occur in Asia, Africa and Latin America, where 44 developing countries have no access to radiotherapy treatment.
3) A $1 investment in radiotherapy yields a $4 return in terms of lives saved and health care costs avoided, showing it is a cost-effective intervention.
Dr. Robert Tauxe - Antimicrobial Resistance and The Human-Animal Interface: T...John Blue
Antimicrobial Resistance and The Human-Animal Interface: The Public Health Concerns - Dr. Robert Tauxe, Deputy Director, Division of Foodborne, Waterborne and Environmental Diseases, US Centers for Disease Control and Prevention, from the 2014 NIAA Symposium on Antibiotics Use and Resistance: Moving Forward Through Shared Stewardship, November 12-14, 2014, Atlanta, Georgia, USA.
More presentations at http://www.swinecast.com/2014-niaa-antibiotics-moving-forward-through-shared-stewardship
The Role of Live Animal Markets in the US and Abroad in the Spread of Zoonoti...JosephGiambrone5
This document discusses the history and spread of avian influenza viruses, including highly pathogenic H5N1, among birds and humans in Southeast Asia since the early 2000s. It notes the first reported outbreaks in birds in 2003-2004 across eight Asian countries and the first reported human cases in Vietnam in 2003. The viruses have continued spreading among birds in the region. It also discusses live bird markets as a source of transmission to humans and notes they have not yet been a source of zoonotic disease transmission in the US. The role of the World Organization for Animal Health in disease surveillance and reporting is highlighted.
The document discusses current transboundary animal diseases (TADs) in the Asia-Pacific region from the perspective of the World Organisation for Animal Health (OIE). It identifies the top 5 priority TADs as foot and mouth disease, highly pathogenic avian influenza, classical swine fever, peste des petits ruminants, and rabies. For each disease, it provides maps showing global and regional distribution and trends over time in the percentage of countries reporting the disease as present or absent. It also discusses OIE standards, reporting systems, and role in facilitating safe international trade in animals and animal products.
COVID-19 is certainly a newly emerged zoonosis, not yet understood properly thus cases need utmost care in its handling in both in human and animals.
More observations and studies can only elucidate the origin, intermediate host and definitive host (till date humans) and maintenance host of SARS CoV-2.
For control of emerging and re-emerging zoonoses potentiating one health environmental approach for understanding disease drivers and control strategies are essential elements.
The Role of Live Animal Markets in the US and Abroad in the Spread of Zoonoti...JosephGiambrone5
Live animal markets have contributed to the spread of zoonotic diseases like avian influenza and coronaviruses. In Southeast Asia, these markets often mix domestic and wild species in unsanitary conditions, allowing viruses to jump between animal hosts and potentially to humans. The first cases of SARS, MERS, and COVID-19 have all been linked to exposure at live animal markets in China, where bats and other wild animals infected domestic livestock. By contrast, live animal markets in the US have strict controls to prevent the introduction of exotic species and do not associate with disease emergence, as animals come from registered sources and are of single species. Uncontrolled live animal markets will continue enabling zoonotic viruses to spillover to humans
This document summarizes Dr. Leslie Ramsammy's concerns about candidates in the 2016 US presidential election linking vaccines to autism and proposing to limit vaccine use without scientific evidence. As a former health minister, Dr. Ramsammy insists that vaccines have significantly reduced child mortality worldwide and calls out Donald Trump, Ben Carson, and Rand Paul for their irresponsible anti-vaccine positions. He is disappointed that prominent health organizations have not more forcefully dismissed these claims and urges taking a public stance to correct misleading statements that endanger children's lives.
Parasitic worms may hold key to cutting spread of hiv researchersBladimir Viloria
Researchers have found that a parasitic worm called schistosomiasis, which infects over 250 million people in developing nations, may be contributing to the spread of HIV. The worms can cause lesions when they lay eggs in women's genital areas, making women three times more likely to contract HIV. Treating the parasitic worm could help reduce HIV transmission, as the drug is inexpensive and donated by the WHO. Additionally, men infected with the worms had HIV viral loads in their semen 10 times higher than uninfected men, but levels returned to normal after treatment. Experts believe addressing this neglected risk factor could significantly help in fighting the HIV epidemic.
This document discusses differences in the spread patterns of various respiratory viruses, including COVID-19, coronaviruses, smallpox, and influenza. It notes that virus size plays a role, with smallpox being larger and spreading mainly through direct contact and droplets, while coronaviruses can spread through airborne transmission as well. Maps and data on outbreaks show that while smallpox took years to spread, COVID-19 increased rapidly in some areas within weeks, indicating differences in transmission. The size of viruses like SARS and influenza fall between smallpox and coronaviruses.
Analysis of H5N1 Influenza Data in Indonesia and the Needs for Improvement - ...Tata Naipospos
Indonesia has experienced widespread H5N1 avian influenza in poultry and 100 human cases. The virus is endemic in birds across 31 of 33 provinces. Three distinct viral sublineages circulate in different regions of Indonesia. Analysis of viral genetics shows the virus spread across the archipelago along trade routes and evolved distinct regional groups. Improved control of poultry movement and vaccination are needed to reduce virus spread and environmental load.
This document contains an examination paper for Managerial Economics. It is divided into three sections: Section A contains 30 multiple choice and short answer questions; Section B contains two case studies with multiple questions each worth 20 marks; Section C contains two long answer theory questions worth 15 marks each. The paper tests concepts related to microeconomics, demand and costs, market structures, national income, and business decision making tools like decision trees.
This document contains 10 multiple choice questions testing knowledge of skeletal muscle structure and function. The questions cover topics like proprioceptors, terminal cisternae, myasthenia gravis, muscle fiber components, skeletal muscle innervation, conditions affecting the neuromuscular junction, and the T-system. An answer key is provided with the correct response for each question.
This document is an examination paper for Semester 1 of the Human Resource Management course at IIBM Institute of Business Management. It contains two sections - Section A with objective type multiple choice and short answer questions, and Section B with two case studies related to HR strategies at telecom companies India Tele Linkages and Kusum Laboratories. The paper tests students' understanding of key HR concepts like performance appraisal, training, compensation and motivation strategies through real-world case examples.
This document contains an exam paper on international business management. It has 3 sections - Section A contains objective type questions, Section B contains case studies, and Section C contains applied theory questions. Section A has 2 parts - multiple choice questions and short answer questions. Section B contains 2 case studies on the EU's competitiveness and the country of Peru. Section C asks students to imagine they are the director of an international lending institution and analyze different export financing instruments. The exam tests students' knowledge of key concepts in international business and their ability to apply theories to real world case studies and scenarios.
This document contains an examination paper for Human Resource Management. It is divided into three sections - Section A contains objective and short answer questions, Section B contains two case studies for analysis, and Section C contains two long form questions requiring explanations of interview types and organizational change and development. The paper tests knowledge across key HR topics like recruitment and selection, performance management, training and development, and managing organizational change. It requires students to apply their understanding of HR concepts to analyze workplace scenarios and explain theoretical HR frameworks.
This document contains an examination paper on Principles and Practices of Management. It is divided into three sections. Section A contains 10 multiple choice questions and 4 short answer questions testing concepts like Maslow's hierarchy of needs, management by objectives, coordination vs cooperation, and theories of authority. Section B presents two case studies, each followed by 2-3 questions requiring analysis and recommendations. Section C asks two long answer questions about drawbacks of classical and neoclassical management theories and defining and comparing training methods. The paper tests a range of foundational management concepts.
This document is an examination paper for a Management Information Systems course. It consists of 3 sections - Section A with multiple choice and short answer objective questions, Section B with two case studies requiring analysis and recommendations, and Section C with two essay questions requiring explanation of e-commerce and database models. The paper tests students' knowledge of key MIS concepts like data warehousing, e-commerce, databases, and how information systems can help analyze business problems and improve decision making.
This document compares and contrasts the leadership styles and careers of Bill Gates and Steve Jobs, the visionaries behind Microsoft and Apple, respectively. It describes how Gates started Microsoft in 1975 and focused on dominating operating systems and office software, while Jobs co-founded Apple in 1976 with a vision of personal computers being easy to use. While Gates recognized the need for professional management, Jobs was overconfident and neglected management. This led to Apple's decline in the 1990s until Jobs returned and revitalized the company, having matured as a leader. It outlines their trajectories through 2006, with Gates focusing on philanthropy through his foundation while preparing new Windows, and Jobs continuing Apple's success after being rehired.
Please read below case and individually take the role of “NGOsAdvoc.pdfpallavi953613
Please read below case and individually take the role of “NGOs/Advocacy Groups” as one of the
important stakeholder.
Discuss the case, from your chosen stakeholder as “NGOs/Advocacy Groups” and perspective
analyzing the reasons for the current situation and the changes you would propose for the future,
supported with additionally researched relevant information.
Please mention your list of references and at least 400 words.
In-Depth Integrative Case 1.2
Pharmaceutical Companies, Intellectual Property,
and the Global AIDS Epidemic
In August 2003, after heavy lobbying from nongovernmental
organizations (NGOs) such as Doctors Without
Borders, the U.S. pharmaceutical industry finally dropped
its opposition to relaxation of the intellectual property
rights (IPR) provisions under World Trade Organization
(WTO) regulations to make generic, low-cost antiviral
drugs available to developing countries like South Africa
facing epidemics or other health emergencies. 1 Although
this announcement appeared to end a three-year dispute
between multinational pharmaceutical companies, governments,
and NGOs over the most appropriate and effective
response to viral pandemics in the developing world, the
specific procedures for determining what constitutes a
health emergency had yet to be worked out. Nonetheless,
the day after the agreement was announced, the government
of Brazil said it would publish a decree authorizing
imports of generic versions of patented AIDS drugs that
the country said it could no longer afford to buy from
multinational pharmaceutical companies. Although the
tentative WTO agreement would appear to allow such
production under limited circumstances, former U.S. trade
official Jon Huenemann remarked, “They’re playing with
fire. . . . The sensitivities of this are obvious and we’re
right on the edge here.”
Despite the role of developed and developing country
governments, NGOs, large pharmaceutical companies,
and their generic competitors in crafting this agreement,
it was unclear how it would be implemented and whether
action would be swift enough to stem the HIV/AIDS epidemic
ravaging South Africa and many other countries.
The AIDS Epidemic and Potential
Treatment
In 2008, after over two decades of fighting the AIDS epidemic
and raising the public awareness, HIV/AIDS still
remained one of the leading causes of death in the world,
occupying the 6th position in WHO Top 10 Causes of
Death list. 3 According to the World Health Organization
(WHO), in 2008 there were approximately 33.4 million
people living with AIDS, with 2.7 million newly infected,
and 2 millions deaths (see Table 1). Since 1980, AIDS has
killed more than 25 million people. HIV is especially
deadly because it often remains dormant in an infected person
for years without showing symptoms and is transmitted
to others often without the knowledge of either person. HIV
leads to AIDS when the virus attacks the immune system
and cripples it, making the person vulnerable to diseases. 4
Th.
Five major pharmaceutical companies have agreed to significantly lower the prices of HIV/AIDS drugs in developing countries. The companies will offer drugs at prices as little as a few pennies above manufacturing costs, representing discounts of 85-90% off prices in wealthy nations. This unprecedented joint agreement was announced by the UN and aims to make life-saving AIDS drugs accessible to more people in Africa, where millions are infected with HIV. However, critics argue that even at the lower prices the drugs will remain out of reach for most Africans and that broader efforts are still needed to address the health infrastructure and prevention in sub-Saharan Africa.
Securing the Global Pharmaceutical Supply Chain against the Threat of Counter...Yasmin AbdelAziz
In 2012, counterfeit versions of the cancer drug
Avastin were found in 19 American treatment
centers. The impostor drug lacked the active
ingredient, rendering it virtually useless for
treatment purposes.
This document provides a historical timeline of key events in the HIV/AIDS epidemic from the 1970s-2002 based on information collected by Dr. MZ. It describes the initial cases identified in the late 1970s, the naming and early reports of AIDS in 1981, the identification of HIV as the cause in 1983-1984, and major developments in treatment, awareness, and global response through the 1990s and early 2000s.
This document provides an overview of malaria, including its epidemiology, history, clinical manifestations, diagnosis, treatment, and global eradication efforts. It discusses how malaria is caused by protozoa and transmitted by mosquitoes. It highlights past Nobel Prize winners for their work on malaria and summarizes current strategies to control and eliminate the disease, including through vaccines, insecticides, drugs, and improved access to care.
Co relation of csf and neurological findings in hiv positive patientsRahul Nirmale
This document provides a literature review on neurological manifestations in HIV positive patients and the correlation with cerebrospinal fluid (CSF) parameters. It summarizes several studies that examined the prevalence and nature of neurological disorders in HIV patients and their relationship to CD4 count and other CSF markers. Many studies found neurological problems to be common and correlated with immunosuppression. Cryptococcal meningitis was a frequent opportunistic infection. Accurately diagnosing neurological conditions is important for treatment, and CSF analysis continues to be useful for this despite modern imaging technologies.
This document discusses challenges to accessing affordable HIV treatment in middle-income countries. It notes that middle-income countries face a "dual burden" of both infectious diseases like HIV and rising non-communicable diseases. Access to affordable medicines is important for universal healthcare but medicines consume a large portion of health spending. The document examines barriers like pricing, patents, intellectual property regimes, and lack of investment that affect access to affordable essential medicines for HIV treatment and other illnesses. It provides context on global commitments to treatment access and reviews the current and future situation for HIV treatment access in middle-income countries.
Steve Jobs was diagnosed with pancreatic cancer at age 48 in 2003, with symptoms starting at age 24. He died from the disease at age 56 in 2011. Vitamin D from moderate sun exposure without sunscreen may help lower the risk of certain cancers like pancreatic, as it is nearly 50% less likely in those with higher vitamin D levels from sun exposure. While surgery, radiation, and chemotherapy have been standard cancer treatments for decades, they have shown little improvement in overall survival rates for all cancers in the last 55 years. Alternative non-toxic treatments exist but are suppressed.
Epidemic diseases are spread by insects passing on microorganisms like bacteria, viruses, and protozoa when they feed or bite. Mosquitoes in particular spread serious epidemic diseases such as malaria, yellow fever, African sleeping sickness, and West Nile virus. Malaria is one of the deadliest diseases worldwide, spread by the bite of the Anopheles mosquito between dusk and dawn across over 100 countries. Yellow fever is also spread by mosquitoes and causes varied symptoms with most improving after a few days but some experiencing liver and kidney failure. Vaccines exist for these diseases but are not always accessible in developing areas.
Tracking the Birth Pains- 9 Deadly Diseases in 2015Beth Frisby
As Messiah's return draws near, deadly diseases will continue to wreak havoc on our world. Take a look at 9 deadly diseases that affected our world in 2015.
Malaria is a serious global health issue caused by parasites transmitted via mosquito bites. It is responsible for millions of deaths each year, especially among young children. While some drug treatments exist, development of new medicines has been lacking. However, a recently patented treatment using colloidal silver has shown promise in resolving malaria symptoms within five days. This over-the-counter formulation could provide an affordable and accessible option for those at risk of contracting malaria.
Experts argue that focusing resources on diseases like HIV, malaria, and tuberculosis prevents neglected tropical diseases from being addressed. These neglected diseases affect over a billion people and could be treated cheaply with drugs costing less than 30p per person. However, health policies disproportionately target higher-profile diseases, ignoring neglected diseases that may cause greater burdens. This wastes an opportunity to eliminate scourges like sleeping sickness, elephantiasis, and river blindness.
The document discusses the pros of animal testing. It notes that polio vaccines developed through animal research eliminated thousands of annual polio cases. Animal testing is regulated by laws like the Animal Welfare Act to ensure humane treatment. However, critics argue that many drugs found safe in animals later fail in humans, questioning the relevance of animal testing.
OMICS Group is an organization committed to making scientific research openly accessible. It hosts over 400 peer-reviewed open access journals and organizes over 300 international conferences annually. The organization has over 3 million readers for its journals. It aims to serve the scientific community by ensuring a rapid peer review process from its large editorial board of over 30,000 reviewers. OMICS Group also partners with over 1000 international societies to make healthcare information openly accessible. It welcomes high-quality research submissions and follows a peer review process to maintain journal excellence.
alhajji1alhajji 2Jafar AlhajjiVaccines Safety and Effectiven.docxsimonlbentley59018
alhajji1
alhajji 2
Jafar Alhajji
Vaccines Safety and Effectiveness
Do you think vaccination is an important or just harmful substance forced by pharmaceutical companies cooperating with the governments to inject into people? Vaccine can be defined as “biological preparations that, when introduced into the body, cause an individual to acquire immunity to a specific disease” (Davidson. 7). So, for decades, vaccines have been considered one of the best revaluation in medical practice. A long time ago, people all around the world tried to fight with different kinds of fatal diseases by different ways, and one of the most Significant ways is to make a vaccine, to prevent such life- threatening diseases. The first vaccine was against the Smallpox disease. Smallpox is a highly contagious disease and caused a lot of fatalities all around the world, and it is transmitted between people by inhalation of droplets of virus or direct contact with smallpox lesion secretions (Davidson 25). It is a deadly disease, it caused blindness and permanent scars in the patients that survived. Finally, after several attempts to make a vaccine for Smallpox, Edward succeeded to produce an effective and safe vaccine in 1796 by using the cowpox vaccine to protect from smallpox. Cowpox is a disease cause by cows and transferred to human, and Jenner’s theory was based that whoever had cowpox will be immunized against smallpox (Davidson 29). “Edward Jenner was an English country doctor who introduced the vaccine for smallpox. Previously a keen practitioner of smallpox inoculation.”
Then, century after century, vaccine after vaccine was developed for different kinds of diseases. In the 20th century, one of the most known vaccines was Diphtheria and Tetanus vaccines. Diphtheria is a respiratory illness, causing the release of exotoxin from Corynebacterium diphtheriae bacteria which leads to death of mucus cells in the throat, mouth and nose, and as a result of cells accumulation the pseudo-membrane are build up and block the airways of the patients which causes death (Davidson 42) After years of experiments and trials to make a vaccine to fight this disease, Gaston Ramon a French veterinarian and biologist who realized that attenuated Diphtheria toxin is able to activate the immune system of people without causing serious side effects, and by 1927, the toxoid vaccine was freely used all around the world, and it succeeds to drop the number of cases of diphtheria. Then, by using the same way of toxoid, combined Diphtheria and Tetanus Toxoid vaccines were produced. Tetanus can be described as a nerves system infection that leads to spasm and contract of body muscles, especially jaw muscles which make the patients unable to open their mouths (Davidson. 44)
Another example of one of the most significant vaccine is a Polio vaccine. Polio disease, mainly affecting children under 5 years old, and leading to paralysis and often to death due to immobilization of respi.
The document summarizes 10 major threats to global health according to the World Health Organization:
1) Air pollution and climate change threaten health through increased deaths from diseases like cancer, stroke and respiratory illnesses.
2) Noncommunicable diseases like heart disease and cancer account for over 70% of deaths worldwide.
3) A global pandemic of an infectious disease like influenza is inevitable and defenses may not be strong enough.
4) Fragile settings with weak health systems and ongoing crises leave over 1.6 billion people without basic care.
5) Antimicrobial resistance threatens modern medicine's ability to treat infections through overuse of antibiotics.
6) Ebola and other high-threat pathogens continue to emerge
Knowledge and Prevalence of HIV/Aids among Suya Vendors in Kafanchan of Jema’...IIJSRJournal
This study was carried out on knowledge and prevalence of hiv/aids among suya vendors in kafanchan of jema’a local government area of kaduna state. To achieve this objective, the researcher developed and administered a questionnaire on eighty respondents. The likert scale statistical and graphical method was used in testing the null hypothesis. From the study, It was observed that The society or public authority do not educate Suya Vendors about Hiv/Aids. Economic status and educational background among Suya Vendors do not determine their knowledge of Hiv/Aids. It was also discovered that parents, religious leaders or government responsible for Hiv/Aids among Suya Vendors. It was observed that that All Suya Vendors are not knowledgeable about their Hiv Status. It was also observed that Suya Vendors negligent in knowing their status. that Suya Vendors do not tell their sexual partners about their Hiv Status. That Suya Vendors have multiple sexual partners. Both the state and federal government should take on joint projects to combat AIDS at the border areas. Projects including training, counselling, public meeting and rallies may be undertaken for awareness-building to this effect. The government should set up blood testing centre across that will be easily accessible, so that the people at Kafanchan municipal areas can get free access to HIV/AIDS testing. Educational Programmes about safe sex should be provided to the illiterate mass. Radio, TV programmes, visual aids and multimedia on AIDS should be produced to augment their awareness level.
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How to Fix the Import Error in the Odoo 17Celine George
An import error occurs when a program fails to import a module or library, disrupting its execution. In languages like Python, this issue arises when the specified module cannot be found or accessed, hindering the program's functionality. Resolving import errors is crucial for maintaining smooth software operation and uninterrupted development processes.
How to Make a Field Mandatory in Odoo 17Celine George
In Odoo, making a field required can be done through both Python code and XML views. When you set the required attribute to True in Python code, it makes the field required across all views where it's used. Conversely, when you set the required attribute in XML views, it makes the field required only in the context of that particular view.
Exploiting Artificial Intelligence for Empowering Researchers and Faculty, In...Dr. Vinod Kumar Kanvaria
Exploiting Artificial Intelligence for Empowering Researchers and Faculty,
International FDP on Fundamentals of Research in Social Sciences
at Integral University, Lucknow, 06.06.2024
By Dr. Vinod Kumar Kanvaria
This presentation was provided by Steph Pollock of The American Psychological Association’s Journals Program, and Damita Snow, of The American Society of Civil Engineers (ASCE), for the initial session of NISO's 2024 Training Series "DEIA in the Scholarly Landscape." Session One: 'Setting Expectations: a DEIA Primer,' was held June 6, 2024.
A review of the growth of the Israel Genealogy Research Association Database Collection for the last 12 months. Our collection is now passed the 3 million mark and still growing. See which archives have contributed the most. See the different types of records we have, and which years have had records added. You can also see what we have for the future.
it describes the bony anatomy including the femoral head , acetabulum, labrum . also discusses the capsule , ligaments . muscle that act on the hip joint and the range of motion are outlined. factors affecting hip joint stability and weight transmission through the joint are summarized.
This presentation includes basic of PCOS their pathology and treatment and also Ayurveda correlation of PCOS and Ayurvedic line of treatment mentioned in classics.
1. The Indian Institute Of Business Management & Studies
Subject: Business Ethics. Marks: 100
Attempt All the case
Case - 1
GlaxoSmitbKine, Bristol – Myers Squibb, and AIDS in Africa 1
In 2004, the United Nations estimated that the previous year 5 million more people around the
world had contracted the AIDS virus, 3 million had died, and a total of 40 million people were
living with the infection. Seventy percent, or about 28 million of these, lived in sub – Saharan
Africa, where the epidemic was at its worst. Sub – Saharan Africa consists of the 48 countries
and 643 million people who reside south of the Saharan desert. In 16 of these countries, 10
percent are infected with the virus, in 6 other nation, 20 percent are infected. The UN predicted
that in these 6 nations two – thirds of all 15 – year olds would eventually die of AIDS and in
those where 10 percent were infected, half of all 15 – year – olds would die of AIDS.
For the entire sub –Saharan region, the average level of infection among adults was 8.8
percent of Botswana’s population was infected, 34 percent of Zimbabwe’s, 31 percent of
Lesotho’s, and 33 percent of Swaziland’s. Family life had been destroyed by the deaths of
hundreds of thousands of married couples, who left more than 11 million orphans to fend for
themselves. Gangs and rebel armies forced thousands of orphans to join them. While crime and
violence were rising, agriculture was in decline as orphaned farm children tried desperately to
remember had to manage on their own. Labor productivity had been cut by 50 percent in the
hardest – hit nations, school and hospital systems were decimated, and entire national economies
were on the verge of collapse.
With its huge burden of AIDS illnesses, African nation desperately needed medicines, both
antibiotics to treat the many opportunistic diseases that strike AIDS victims and HIV
antiretrovirals that can indefinitely prolong the lives of people with AIDS. Unfortunately, the
people of sub – Saharan Africa could not afford the prices that the major pharmaceutical drug
companies charged for their drugs. The major drug companies, for example, charged $10,000 to
$ 15,000 for a year’s supply the antiretrovirals they marketed in the United States. Yet the
average per –person annual income in sub – Saharan Africa was $500. the AIDS crisis in sub –
Saharan Africa posed a major moral problem for the drug companies of the developed world:
How should they respond to the growing needs of this terribly destitute region of the world?
These problems were especially urgent for the companies that held patents on several AIDS
antiretrovirals, such as GlaxoSmithKline and Bristol- Myers Squibb.
GlaxoSmithKline, a British pharmaceutical company founded in 1873, with 2003 revenues
of $38.2 billion and profits of $8 billion, held the patents to five antiretrovirals it had created.
Formed from the merger of three large drug companies (Glaxo, Burroughs Wellcome, and
SmithKline Beecham), it was one of the world ‘s largest and most profitable companies. Bristol
– Myers Squibb, an American pharmaceutical company founded in 1858, was also the result of
mergers (between Squibb and Bristol – Myers). It had 2003 profit of $$3.1 billion on revenues of
$20.8 billion ad had created and now held the patents to two antiretrovirls.
Although AIDS was first noticed in the United State in 1981 when the CDC noted an
alarming increase of a rare cancer among gay man, it is now known to have afflicted a Bantu
male in 1959, and possibly jumped from monkeys to humans centuries earlier. In 1982, with
1,614 diagnosed cases in the United State, the disease was termed AIDS (for “acquired immune
2. The Indian Institute Of Business Management & Studies
Subject: Business Ethics. Marks: 100
deficiency syndrome”), and the following year French scientists identified HIV (Human
Immunodeficiency Virus) as its cause.
HIV is a virus that destroys the immune system that the body uses to fight off infections
and diseases. If the immune system breaks down, the body is unable to fight off illnesses and
becomes afflicted with various “opportunistic diseases “- infections and cancers. The virus,
which can tack up to 10 year to break down a person’s immune system, is transmitted through
the exchange of body fluids including blood, semen, vaginal fluids, and breast milk.
The main modes of infection are through unprotected sex, intravenous drug use, and child
birth. In 1987, Burroughs Wellcome (now part of GlaxoSmithKline) developed AZT, the first
FDA-approved antiretroviral, that is, a drug that attacks the HIV virus itself. When wellcome
priced AZT at $10,000 for a year’s supply, it was accused of price gouging, forcing a price
reducing of 20 percent the following year. In 1991, Bristol- Myers Squibb developed didanosine,
a new class of antiretroviral drug called nucleoside reverse transcriptase inhibitors. In 1995,
Roche developed saquinavir, a third new class of antiretroviral drug called a protease inhibitor,
and the following year Roxane Laboratories announced nevirapine, another new class of
antiretrovirals called nonnucleoside reverse transcriptase inhibitors . By the middle 1990s, drug
companies had developed four distinct classes of antiretrovirals, as several drugs that attacked
the opportunistic diseases that afflict AIDS patients.
In 1996, Dr. David Ho was honored for his discovery that by taking a combination- a
“cocktail”- of three of than four classes of antiretroviral drags, it is possible to kill off virtually
all of than HIV virus in a patient’s body, allowing the immune system to recover, and thereby
effectively bringing the disease into remission. Costing upwards of $20,000 a year (the
medicines had to be taken for the rest of the patient’s life), the new drug treatment enabled AIDS
patients to once again live normal, healthy lives. By 1998, the large drug companies would have
developed 12 different antiretroviral drugs that could be used in various combination to from the
“cocktails” that could bring the disease into remission. The combination drug regimes, however,
were complicated and had to be exactly adhered to. Several dozen pills had to be taken at various
specific times during the day and night, every day, or the treatment would fail to work and the
patient’s HIV virus could be come resistant to the drugs. If the patient then spread the disease to
others, it would give rise to drug – resistant version of the disease. To ensure patients were
carefully following the regimes, doctors or nurses carefully monitored their patients and made
sure patients took the drugs on schedule. In 1998, as more U.S AIDS patients began the new
combination drug treatment, the number of annual AIDS deaths dropped for the fist time in the
United states.
Globally, however, the situation was not improving. By 2000, according to the United
Nations, there were approximately 5 million people who were being newly infected with AIDS
each year, bringing the worldwide total to about 34,300,000, more than the entire population of
Australia. Approximately 3,000,000 adults and children died of AIDS each year.
The price of the new combination antiretroviral treatment limited the use of these drugs
to the United States and other wealthy nation. Personal incomes in sub – Saharan Africa were too
low to afford what the combination treatments cost at the point. Yet the countries of sub –
Saharan Africa were emerging as the ones most desperately in need of the new treatment. Of the
5 million annual new cases of ADIS, 4 million -70 percent – were located in sub- Saharan
countries.
Numerous global health and human rights groups – such as Oxfam – urged the large drug
companies to lower the prices of their drugs to levels that patients in poor developing nations
3. The Indian Institute Of Business Management & Studies
Subject: Business Ethics. Marks: 100
could afford. By 2001, a combination regime of three antiretroviral AIDS drugs still cost about
$10,000 a year. Although the formulas for making the antiretroviral drugs were often easy to
obtain, few poor countries had the ability to manufacture the drugs, and in most nations that had
the capacity to manufacture drugs the large drug companies of the developed world had obtained
“patents” that gave them the exclusive right to manufacture those drugs in effect making the drug
formulas the private property of the large drug companies.
GlaxoSmithKline, Bristol – Myers Squibb, and the other big drug companies did not at
this time want to lower their prices. First, they argued that it was better for poor countries to
spend their limited resources on educational programs that might prevent new cases of AIDS
than on expensive drugs that would merely extend life for the small number of patients that
might receive the drugs. Second, they argued that the combination drug “cocktails” had to be
administered by hospitals, clinics, doctors, or nurses who could monitor patients to make sure
they were taking the drugs according to the prescribed regimes and to ensure that drug- resistant
versions of the virus did not develop. But most AIDS patients in developing nations such as
those in sub-Saharan Africa, the big drug companies argued, had limited access to medical
personnel. Third, they argued, the development of new drugs was extremely expensive. The cost
of the research, development, and testing required to bring a new drug to market, they claimed,
was between $100 million. Besides the research involved, new drugs had to be tested in three
phases: Phase I trials to test for initial safety: Phase II trials to test to make sure the drugs work:
and Phase III trials that were wide-scale tests on hundreds of people to determine safety,
efficacy, and dosage. If the big drug companies were to recover what they had invested in
developing the drugs they marketed, and were to retain the capacity to fund new drug
development in the future, they argued, they had to maintain their high prices. If they started
giving away their drugs, they would stop making new drugs. Finally, the drug companies of the
developed nations feared that any drugs they discounted or gave away in the developing world
would be smuggled back and sold in the United States and other developed nations.
Critics of the drug companies were not convinced by these arguments. Doctors Without
Borders- a group of thousands of doctors who contributed their services to poor patients in
developing nations around the world- said that although prevention programs were important,
never- the less hundreds of thousands of lives-even millions-could be saved if drug companies
lowered their antiretroviral and opportunistic disease drug prices to levels poor nations could
afford. Moreover, a September 2003 report by the International AIDS Society stated that studies
in Brazil, Haiti, Thailand, and South Africa showed that patients in remote rural areas adhered
exactly to their drug regimes with the help of low-skilled paramedics and that the development
of resistance was not a major problem. In fact, in the United States 50 percent of AIDS patients
had developed drug resistance but only 6.6 percent of AIDS patients studied in developing
nations had developed resistance. By now, some of the antiretroviral combination treatments
were being combined into blister packs that were easier to administer and monitor.
Other critics challenged the financial arguments of the drug companies. The cost
estimates of new drug development used by the drug companies, they claimed, were inflated. For
example, the figure of $500 million that drug companies often cited as the cost of developing a
new drug was based on a study that inflated its cost estimates by doubling the actual out-of-
pocket costs companies invested in a drug to account for so-called “opportunity” costs (what the
money would have earned if it had been invested in some other way). Moreover, these cost
estimates assumed that the drug was being developed from scratch, when in fact most of the new
drugs marketed by companies were based on research for other drugs already on the market or on
4. The Indian Institute Of Business Management & Studies
Subject: Business Ethics. Marks: 100
research conducted by universities, government, and other publicly funded laboratories. Critics
also questioned whether companies would be driven to stop investing in new drugs if they
lowered the pries of their AIDS drugs. Since 1988 the average return on equity of drug
companies averaged an unusually high 30 percent a year. Public Citizen, in a report entitled
“2002 Drug Industry Profits,” noted that the ten biggest drug companies had total profits in 2002
of $35.9 billion, equal to more than half of the $69.6 billion in profits netted by all other
companies in the Fortune 500 list of companies (the 500 largest U.S. companies). The ten big
drug companies made 17 cents for every dollar of revenue, while the median earnings for other
Fortune 500 companies was 3.1 cents per dollar of revenue; the return on assets of the big
companies was 14.1 percent while the median for other companies was 2.3 percent. During the
1990s, the big drug companies in the Fortune 500 had a return on revenues that was 4 times the
median of all other industries, and in 2002 it was at almost 6 times the median. Finally, the report
noted, while the big drug companies spent only 14 percent of their revenues on drug research,
they plowed 17 percent of their revenues into profit and 31 percent into marketing and
administration. GlxoSmithKline itself had a 2003 profit margin of 21 percent, a return on equity
of 122 percent, and a return on assets of 26 percent; Bristol-Myers Squibb had a profit margin of
19 percent, return on equity of 36 percent, and return on assets of 14 percent. These figures,
critics argued, showed that it was well within the capacity of the big drug companies to lower
prices for AIDS drug to the developing nations, even if a small portion of these drug ended up
being smuggled back into the United States.
GlaxoSmithkline, Bristol-Myers Squibb, and the other big drug companies, however, held
their ground. Throughout the 1990s, they had lobbied hard to ensure that governments around the
world in the medicines they had created. Before 1997, countries had different protection on so-
called “intellectual property” (intellectual property consists of intangible property such as drug
formulas, designs, plans, software, new inventions, etc.) some countries, like the United States,
gave drug companies the exclusive right to keep anyone else from making their newly invented
drug for a period of 15-20 year (this right was called a “patent”); other countries allowed
companies fever year of protection for their patents, and many developing countries (where little
research was done and where few things intellectual property as something that belonged to
everyone and so something that should not be patented. Some countries, like India, offered
patents that protected the process by which a drug was made but allowed others to make the
same drug formula if they could figure out another process by which to make it.
Arguing that research and development would stop if new invention such as drug were not
protected by strong laws enforcing their patents, GlxoSmithKline, Bristol- Meyers Squibb, and
the other major drug companies intensely lobbied the World Trade Organization (WTO) to
require all WTO members to provide uniform patent protections on all intellectual property.
Pressured by the governments of the large drug companies (especially the United States), the
WTO in 1997 adopted an agreement known as TRIPS, shorthand for Trade-Related aspects of
Intellectual Property rights. Under the TRIPS agreement, all countries that were members of the
WTO were required to give patent holders (such as drug companies) exclusive right to make and
market their inventions for a period of 20 yea in their countries. Developing countries like India,
Brazil, Thailand, Singapore, China, and the sub – Saharan nation-were give until 2006 before
they had to implement the TRIPS agreement. Also, I a “national emergency” WTO developing
countries could use “compulsory licensing” to force a company that owned a patent on a drug to
license another company in the same developing country to make a copy of that drug. And in a
national emergency WTO developing countries could also import drug from foreign companies
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even if the patent holder had not licensed those foreign companies to make the drug. The new
TRIPS agreement was a victory for companies in developed nation, which held patents for most
of the world’s new inventions, while it restricted developing nation whose own laws had earlier
allowed them to copy these inventions freely. The big drug companies were not willing in 2000
to surrender their hard-won 1997 victory at the WTO.
Because the AIDS crisis was now a major global problem, the United Nation in 2000
launched the “Accelerated Access Program,” a program under which drug companies were
encouraged to offer poor countries price discounts on their AIDS drug. GlaxoSmithKline and
then Bristol-Myers Squibb joined the program, but the price discounts they were willing to make
were insufficient to make their drug affordable to sub-Saharan nations, and only a few people in
few countries received AIDS drug under the program.
Everything changed in February 2001 when Cipla, an Indian drug company, made a
surprise announcement: It had copied three of the patented drug of three major pharmaceutical
companies (Bristol-Myers Squibb, GlxoSmithKline, and Boehringer Ingelheim) and put them
together into a combination antiretroviral course of therapy. Cipla said it would manufacture and
sell a year’s supply of its copy of this antiretroviral “cocktail” for $350 to Doctors Without
Borders. This was about 3 percent of the price the big drug companies who held the patents on
the drugs were charging for the same drugs.
GlxosmithKline and Bristol-Myers Squibb objected that Cipla was stealing their
property since it was copying the drug that they had spent million to create and on which they
still held the patent. Cipla responded that its activities were legal since the TRIPS agreement did
not take effect in India until 2006, and Indian patent low allowed it to make the drugs so long as
it used a new “process.” Moreover, Cipla claimed, since AIDS was a national emergency in
many developing countries, particularly the sub-Saharan nations, the TRIPS agreement allowed
sub-Saharan nation to import Cipla ‘s AIDS drugs. In August 2001, Ranbaxy, another Indian
drug company, announced that it, too, would start selling a copy of the same antiretroviral
combination drug Cipla was selling but would price it at $295 for a year’s supply. In April 2002,
Aurobindo, also an Indian company, announced it would sell a combination drug for $209.
Hetero, likewise an Indian company, announced in March 2003 that it would sell a combination
drug at $201. By 2004, the Indian company were producing versions of the four main drug
combination recommended by the World Health Organization for the treatment of AIDS. All
four combination contained copies of one or two of GlaxoSmithKline’s patented antiretroviral
drugs and two of the combination contained copies of Bristol-Meyer Squibb’s patented drugs.
The CEO of GlaxoSmithKline branded the Indian companies as “pirates” and asserted
that what they were doing was theft even if they broke no laws. Pressured by the discounted
prices of the Indian companies and by world opinion, however, GlaxoSmithKline and Bristol-
Myers Squibb now decided to further discount the AIDS drugs they owned. They did not,
however, lower their prices down to the levels of the Indian companies; their lowest discounted
prices in 2001 yielded a price of $931 for 1-year supply of the combination of AIDS drugs Cipla
was selling for $350. In 2002 and 2003, new discounts brought the combination down to $727,
still too high for most sub-Saharan AIDS victims and their government.
With little to impede its progress, the AIDS epidemic continued in 2994. Swaziland
announced in 2003 that 38.6 percent of its adult population was now infected with AIDS. THE
United Nation estimated that every day 14,000 people were newly infected with AIDS. The
World Health Organization announced that only 300,000 people in developing countries were
receiving antiretroviral drugs, and of the 4.1 million people who were infected in sub-Saharan
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Africa only about 50,000 had access to the drugs. The World Health Organization announced in
2003 that it would try to collect from governments the funds needed to bring antiretrovirals to at
least 3 million people by the end of 2005.
Questions
1. Explain, in light of their theories, what Locke, Smith, Ricardo, and Marx would probably
say about the events in this case.
2. Explain which view of property-Locke’s or Marx’s- lies behind the positions of the drug
companies GlaxoSmithKline and Bristol-Myers Squibb and of the Indian companies such
as Cipla. Which of the two group-GlaxoSmithKline and Bristol-Myers Squibb on the one
hand, and the Indian companies on the other –do you think holds the correct view of
property in this case? Explain your answer.
3. Evaluate the position of Cipla and of GlaxoSmithKline in terms of utilitarianism, right,
justice, and caring. Which of these two positions do you think is correct from an ethical
point of view?
Case - 2
Playing Monopoly: Microsoft
On November 5, 1999, then the richest man in the world, learned that a federal judge, Thomas
Jackson, had just issued “findings of fact” declaring that his company, Microsoft, “enjoys
monopoly power” and that it had used its monopoly power to “harm consumers” and crush
competitors to maintain its Windows monopoly and to establish a new monopoly in Web
browsers by bundling its Internet Explorer with Windows. On the day the judgment was issued,
Microsoft stock began its decline. The decline was hastened by an announcement in February
2000 that the European Commission, which enforces European Union lows on competition and
monopolization, had been investigating Microsoft’ anticompetitive practices in server software
since 1997 and was extending its investigation to look into Microsoft’s bundling of its Windows
Media Player with Windows. Two months later, on April 3,2000,U.S. judge Thomas Jackson
issued a second verdict, concluding on the basis of his earlier findings of fact that Microsoft had
violated U.S. antitrust low and was subject to the penalties allowed by the low. The price of
Microsoft stock plunged, bringing the entire stock market down with it. Two short months later,
on June 7,2000, Judge Jackson ordered that Microsoft should be broken up into two separate
companies-one devoted to operating systems and the other to applications such as word
processing, spreadsheets, and Web browsers. With the price of Microsoft stock now skidding,
Gates, who was no longer the richest man in the world, vowed that Microsoft would appeal this
and any similar verdict and would never be broken apart.1
Bill Gates was born in 1955 in Bremerton, Washington. When he was 13 years old, his
grammar school acquired a computer terminal, and by the end of the year he had written his first
software program (for playing tictac-toe). During high school, he held a few entry-level
programming jobs. Gates enrolled in Harvard University in 1974, but quickly lost interest in
classes and quit to start a software business in Albuquerque, New Mexico, with a friend, Paul
Allen, whom he had known since grammar school in Seattle. At the time, the first small but
primitive personal computers were being manufactured as kits for hobbyists. These computers,
like the Altair 8080 computer (which used Intel’s new 8080 microprocessor, had no keyboard, no
screen, and only 256 bytes of memory), had no accompanying software and were extremely
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difficult to program because they had to use “machine code” (consisting entirely of sequences of
zero and ones), which is virtually incomprehensible to humans. Gates and Allen together revised
a program called BASIC (Beginner’s All – Purpose Symbolic Instruction Code, a program
written several years earlier by two engineers who gave it away for free), which allowed users to
write their own programs using an understandable set of English instructions, and they adapted it
so that it would work on the Altair 8080. They sold the adaptation to the maker of the Altair
8080 for $3,000.
In 1977, Apply Computer marketed the first personal computer (PC) aimed at consumers,
and by 1978, more than 300 dealers were selling the “Apply II.” That year, Gates and Allen
began writing software programs for the Apply II, renamed their company Microsoft, and moved
it to Seattle, where, with 13 employees, it ended the year with revenues of $1.4 million. In 1979,
two hobbyists developed VisiCalc, the first spreadsheet program, for the Apply II, and Microsoft
developed MS Word, a rudimentary word processor for the Apply II. With these new software
“applications,” sales of the Apply II took off and the personal computer market was born. By
1980, Microsoft, which continued writing programs for the growing personal computer market,
had earning of $8 million.
In 1980, IBM belatedly decided to enter the growing market for personal computers. By
now many other companies had flocked into the PC market, including Radio Shack,
Commodore, COMPAQ, AT&T, Xerox, DEC, Data General, and Wang. By 1984, some 350
companies around the world would be making PCs. Because IBM needed to enter the market
quickly, it decided to assemble its computer from components that were readily available on the
market. A key component that IBN needed for its computer was an operating system. An
operating system is the software that allows application programs (like a world processor,
spreadsheet, browser, or game) to run on a particular machine. Every computer must have an
operating system or it cannot run any application programs. The operating system coordinates
the various components of the computer (keyboard inputs, monitor, printer, ports, etc. and
contains the application programming interface (API), which consists of the codes that
application use to “command” the computer to carry out its function. Application programs, such
as a games or world processors, are written so that they will run on a specific operating system
by making use of that operating system’s API to make the computer carry out the program’s
commands. Unfortunately, a program written for one operating system will not work on another
operating system. Most of the companies making PCs had developed their own operating
systems, although several made use of one called CP/M, which was written to work on many
different computers, applications developed to run on CP/M. This meant that an application did
not have to be rewritten for each different kind of computer, but could be written once for CP/M
and would then on any computer using CP/M.
IBM needed an operating system quickly and approached the maker of CP/M for a license
to use CP/M but was turned down. The somewhat desperate IBM representatives then met with
Bill Gates to ask whether Microsoft had one available. Although Microsoft at the time did not
own an operating system, Bill Gates told IBM that he could provide one to them. Immediately
after the IBM meeting, Bill Gates went to a friend who he knew had written an operating system
that was a “knock-off of CP/M” and that could work on the computer IBM was planning.
Without telling his friend about the meeting with IBM, Gates offered to buy his friend’s
operating system for $60,000. The friend agreed. After some tweaking, Microsoft licensed the
system to IBM as MS-DOS, with the proviso that Microsoft could also license MS-DOS to other
computer manufactures. When IBM started mass-producing its personal computer in 1981
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(IBM’s share of the market went froe nothing in 1981, to 10 percent in 1983, and 40 percent
in1987) and other computer makers began producing copies of IBM’s computer, MS-DOS
become the standard operating system for personal computers built according to IBM’s
standards. Bill Gates’s company was on its way to becoming a billion-dollar firm.
Because an application program has to be written to work on a specific operating system,
and because so many personal computers were now using the MS-DOS operating system,
software companies were much more willing to created programs for the large market of MS-
DOS users than for the much smaller numbers of people using other competing operating system
numbers of people using other competing operating systems. As thousands of new software
programs were developed for MS-DOS-including Microsoft’s own spreadsheet, Multiplan, and
its word processor, MS Word even more people adopted MS-DOS, initiating what economists
call a network effect. A product creates a network effect when the value of the product to a buyer
depends on how many other people have already bought the product. A standard example of a
product that creates a network effect is a communication network like a telephone network. The
more people that are connected to a telephone network, the more valuable it will be for a new
subscriber to be connected to the network since he can communicate with more people. Many
products besides communication networks can give rise to network effects, including, of course,
operating systems. The more people that own an operating system, the more that software
companies are willing to write programs for that operating system. The more software program
they write for the operating system, the more people want to buy that operating system. Because
of this network effect, the proportion of computers using MS-DOS quickly increased, and the
proportion of computers using other operating systems (such as CP/M, Apply computer’s, or
Atari’s or commodore’s) declined.
However, in 1984, Apple Computer developed an innovative new operating system for its
own computers that used intuitive graphics or pictures that let users issue commands to the
computer by selecting icons and pull-down manus on the screen using the mouse. The new
operating system was tremendously popular, and Apple sales began to climb. In 1987, however,
Microsoft began selling Windows, a new operating system for IBM-compatible computers that
copied Apple’s operating system. Unlike MS-DOS, which had used obscure combinations of
characters to issue commands to the computer, Windows used graphics that were similar to
Apple’s, had virtually the same pull-down menus and icons, and the same usage of the same
mouse. Apple sued Microsoft on the grounds that, in copying the “look and feel” of their
operating system, Microsoft had stolen a key piece of their copyrighted property. Apple lost the
suit and, with the loss of its key software advantage, its market share withered away.
Although early versions of Windows were not very good quality improved over the
years. In 1995 Microsoft issued Windows 95, in 1998 it issued windows 98, in 2000 it issued the
Millennium version of Windows, and two years later it issued Windows XP. The next version
of Windows was code-named “Longhorn.” As the new millennium began, Microsoft controlled
90 percent of the personal computer operating system market-a virtual monopoly- and Bill Gates
was fabulously rich. .
In the early 1990s, however, two threats to Microsoft’s monopoly had emerged.2 one
was Netscape, an Internet browser, and the other was Java, a programming language. The
Internet is a network through which digital information, pictures, sounds, text, and other digital
data can be sent from one computer to another. To make these data usable, a user’s computer
must be connected to the Internet and must have a software program called a browser. The
browser takes the digital data that come through the Internet and transforms them into an
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intelligible picture or text that can be displayed on the user’s computer screen or into a sound
that can be played on the computer’s speakers. However, a browser is not only capable of
interpreting digital data that come over the Internet, it can also execute the instructions of
software programs, whether those programs are sent over the Internet or reside in the user’s own
computer. In this respect, a browser functions much like an operating system. Some people
predicted that someday every computer might rely on a browser instead of an operating system
to run software programs. Although the browser would still need some rudimentary operating
system to run, this operating system did not have to be Windows. Windows could become
obsolete. Netscape, a company that began selling a browser named Navigator on December 15,
1994, quickly captured 70 percent of the browser market. In May 1995, Bill Gates wrote an
internal memo to his executives, warning:
A new competitor “born” on the Internet is Netscape. Their browser is dominant, with a
70% usage share, allowing them to determine which network extension will catch on. They are
pursuing a multi-platform strategy where they move the key API [applications programming in
derlying operating system.]
In addition to the browser threat, Microsoft was also worried about Java, a programming
language that Sun Microsystems, a manufacture of computer hardware and software, had
developed in May 1995. programs that are written in the Java language can operate on any
computer equipped with java software, regardless of the operating system the computer used. In
this respect, java software also could function like an operating system and also threatened to
make Widows obsolete. In an internal memo, a Microsoft senior executive stated that Java was
“our major threat,” and in September 1996, Bill Gates wrote an e-mail saying, “This scares the
hell out of me,” and asked manager a to make it a top priority to neutralize Java.
To make matters worse, Java and Netscape joined forces. Netscape agreed to incorporate
the Java software into its Navigator browser so that any programs written in Java would work on
a computer that was using Netscape. This meant that short programs written in Java could be
sent over the Internet and then run on the user’s computer through its Netscape browser. This
also meant that Java programs did not need windows, but could run on any computer using any
operating system so long as it was also using Netscape’s Navigator Browser. Because Java was
now being distributed together with Netscape, the number of computers equipped with Java
rapidly multiplied. A Microsoft had become the “major distribution vehicle” for Java.
According to the “findings of fact” accepted by the judge presiding over the” major
distribution vehicle” for Java.
According to the “findings of fact” accepted by the judge presiding over the Microsoft
antitrust trial, Microsoft quickly embarked on a campaign to undercut the threat that Netscape
now posed to its monopoly. First, a team of Microsoft executives met with Netscape’s executives
in June 1995. Microsoft’s people proposed that Microsoft should provide the browser for
Windows computers while Netscape should provide browsers for all other computers essentially
the 10 percent of computers that ran on Apple’s operating system, on OS/2, or on other relatively
minor operating system. A memo written the next day by a Microsoft executive who was percent
stated that a goal of the meeting was to “establish Microsoft ownership of the Internet client
platform for Win95.” Netscape refused to go along with this plan to divide the browser market.
Microsoft then refused to share the codes for Windows 95 so that Netscape would be unable to
develop a browser for Windows 95. Netscape had to wait several months after Windows 95 was
released before it finally got hold of its codes and was finally able to develop a new version of
Navigator that would take advantage of the Windows 95 applications interface.
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Microsoft also develop its own browser by borrowing a browser program it had earlier
licensed from Spy-glass Inc, renaming it Interner Explorer, and copying many of Netscape’s
features onto its. (The chairman of Spyglass later complained that “whenever you license
technology to Microsoft, you have to understand it can someday build it itself, drop it into the
operating system, and put you out of that business.” Unfortunately, when Microsoft tried to sell
its browser in 1995, users felt it was inferior to Netscape and sales lagged. Microsoft continued
working on its browser and its fourth version, Internet Explorer 4.0, released in late 1997, finally
began to be compared favorably to Netscape’s browser. Still, few people were buying internet
Explorer. Microsoft then decided to use its operating system monopoly to undercut Netscape. In
February 1997, Christian Wildfeuer, a Microsoft executive, suggested in an internal memo that it
would “be very hard to increase browser share on the merits’ of internet Explorer 4 alone. It will
be more important to leverage our Operating System asset to make people use Internet Explorer
instead of Netscape’s Navigator.” If Internet Explorer was bundled together with Windows, so
that when Windows was installed on a computer Internet Explorer was also automatically
installed, then users would tend to use Internet Explorer rather then go through the expense and
trouble of purchasing and installing Netscape. Accordingly, Microsoft incorporated a copy of
Internet Explorer into Windows 95 that automatically installed itself when Windows was
installed. Windows 98 went farther by integrating Internet Explorer into the operating system so
that it was extremely difficult for a user even to remove Internet Explorer. Moreover, when a
user “uninstalled” Internet Explorer, it stayed in the computer and still appeared when Windows
98 was running certain commands. Although this integration made Windows 98 run more slowly
and consumed resources on the user’s computer, it also made it much more difficult and risky for
users to try to replace Internet Explorer with Netscape Navigator. Microsoft claimed that it was
now giving Internet Explorer away “for free,” but skeptics pointed out that the costs of
developing the browser had to be recovered from sales of Windows and so a portion of what the
consumer paid for a copy of Windows went to pay for the costs of developing the browser.
Microsoft did more than bundle Internet Explorer with Windows. According to the court’s
“findings of fact,” Microsoft required any computer maker that wanted Windows on its
computers to agree that it would not remove Windows Explorer and would not promote
Netscape’s browser. If a computer maker also agreed to not even give its customers a copy of
Netscape, Microsoft discounted the price of Windows. Because Microsoft’s monopoly meant
that computer manufacture either had to install Windows on their computers or make them
virtually useless, manufactures had no choice but to sign the agreements that shut Netscape out
of the market. Although users were still able to buy a copy of Netscape from a retailer, the
number of users doing this declined. Not only would purchasing a copy of Netscape require
paying extra for software that would do much of what their installed Internet Explorer could
already do but also required that trick task of removing Internet Explorer from their computers
and in selling Netscape in its place. Not surprisingly, Netscape’s share of the market rapidly
dropped, and Internet Explorer’s rapidly rose- a successful outcome of Wildfeuer’s strategy “to
leverage our Operating System asset to make people use Internet Explorer instead of Navigator.”
Microsoft dealt with its Java threat by asking Sun Microsystems for the right to license and
distribute Java with its Windows system. Sun Microsystems gave Microsoft that right, not
knowing that Microsoft was planning to change Java. The version of Java that Microsoft
distributed was a version that incorporated several changes that would no longer allow regular
Java programs to run on computers using Microsoft’s Java. Thus, there were now two versions
of Java, and the version that most users were getting installed with their Windows computers
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was a version that was incompatible with the regular version of Java and that Microsoft now
owned. Microsoft had apparently planned this move because an earlier internal Microsoft
document stated that it was a “strategic objective” for Microsoft to “Kill cross-platform Java” by
expanding the “polluted Java market”- a reference to Microsoft’s own “polluted” version of Java.
Because all Windows-based computers now incorporated a copy of Microsoft’s Java, not Sun’s.
Microsoft encouraged these developers by offering them special technical support and
inducements. In effect, Microsoft had turned Java into a part of Windows so that there was now
little threat that Windows would be rendered obsolete by Java.
But on May 18, 1998, the U.S. Department of Justice (DOJ), then headed by U.S. Attorney
General Janet Reno (an appointee of Democratic President Bill Clinton), filed an antitrust suit
Microsoft in Judge Jackson’s court, claiming that the company had violated the Sherman
Antitrust Act by engaging in “a pattern of anticompetitive practices designed to thwart browser
competition on the merits, to deprive customers of choice between alternative browsers, and to
exclude Microsoft’s Internet browser competitors,” especially Netscape and java.3 the DOJ
claimed that Microsoft had violated the antitrust act in four ways: (a) Microsoft had forced
computer companies that used its Windows operating system to sing agreements that they would
not license, distribute, or promote software products that competed with Microsoft’s own
software products; (b) Microsoft “tied” its own browser, Internet Explorer, to its Windows
operating system so that customers who purchased Windows also had to get Internet Explorer,
although these were separate products and tying the two products together degraded the
performance of Windows; (c) Microsoft had attempted to use its operating system monopoly to
gain a new monopoly in the Internet browser market by forcing computer companies that used its
Windows operating system to agree to leave Internet Explorer as the default browser and to
preinstall or promote the browser of any other company; and (d) Microsoft had a monopoly in
the market for PC operating system and had used anticompetitive and predatory tactics to
maintain its monopoly power. As a penalty to ensure that Microsoft not engaged in such
behaviors again, the DOJ recommended that that the part of the company devoted to cresting
Windows should be spun off and separated from the part that developed browsers and other
software applications.
On June 7, 2000, Judge Jackson found Microsoft guilty of counts b, c and d, and ordered that
the company be broken up into two separate companies-one to develop and market operating
systems and the other to develop and market all other Microsoft programs. Although the judge
could have simply ordered Microsoft to cease engaging in the illegal practices, he feared that
policing such an order would require so much government oversight that it was simply not
practical. The judge also ruled that the two new companies would not be allowed to share any
technical information with each other that they did not share with all their other customers. Not
could Microsoft punish or threaten any computer manufacturers for distributing or promoting the
products or services of its competitors. Finally, Judge Jackson ordered that Microsoft had to let
computer manufactures remove any Microsoft applications from its Windows operating system.4
the Judge ruled, however, that Microsoft would not have to implement his orders until it had time
to appeal his decision. In a defensive “white paper,” Microsoft stated:
Antitrust policy seeks to promote low prices, high output, and rapid innovation. On all three
measures, the personal computer software industry generally-and Microsoft in particular-is a
model of competitiveness…. Market share numbers do not reflect the highly dynamic nature of
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the software industry, where entire business segment can disappear virtually overnight as new
technologies are developed.
Microsoft claimed that it was responsible for much of the innovation that characterized the
software industry. In addition, it claimed that its actions, including its decision to bundle Internet
Explorer with Windows and its decision to “improve” Java by changing it, were all done to help
consumers and give them more value for their money.
Microsoft appealed the judge’s verdict, and on June 28, 2001, a federal appeals court
reversed Judge Jack-son’s breakup penalty. The federal appeals court held that, based on
interviews he gave to the news media during the case, Jackson appeared to be biased against
Microsoft, and this bias might have affected the severity of the penalty he had imposed on the
company. Although Jackson’s findings of fact were to remain in place, the appeals court held
that a new penalty would have to be devised for the company.
The previous year, however, George W. Bush had been inaugurated president and his
administration had as signed a new person, John Ashcroft, as the new attorney general to head up
the Department of Justice. According to Edward Roeder, an expert on corporate political
contributions, in the previous 5 year Microsoft had begun contributing heavily to the Republican
Party’s election campaigns, contributing about 75 percent of its $6million-dollar-a-year 2000
political contributions to Republicans, creating “an unprecedented campaign to influence the new
Administration’s antitrust policy,” and to “escape from the trial with its monopoly intact.”5 on
September 6,2001, the new Republican-appointed head of the DOJ announced that it would no
longer seek the breakup of Microsoft but would, instead, seek a lesser penalty. Two months later,
on November 2,2001, the DOJ announced that it had reached a settlement with Microsoft.
According to the agreement, Microsoft would share its application programming interface with
other rival software companies who wanted to write applications (such as word processing
programs or games) that could run on Windows; it would have to give computer makers and
users the ability to hide icons for Windows applications, such as the icon for Internet Explorer or
for Microsoft’s digital media player; it could not prevent competing programs from being
installed on a Windows computer; it could not retaliate against computer makers who used
competing software. A three-person panel would be given complete access to Microsoft’s
records and source code for the next 5 years to ensure that Microsoft complied with the
agreement. Microsoft; however, would not be prevented from bundling whatever software
programs it wanted with its Windows operating system. The new judge appointed to case, Judge
Colleen Kollar-Kotelly, reviewed the settlement and on November 1,2003, she handed down a
decision essentially ratifying the settlement between Microsoft and the DOJ. The state of
Massachusetts and two computer trade groups, however, who objected to the settlement as a
mere slap on the wrist, filed an appeal, arguing that Microsoft’s monopolistic behaviors drserved
tougher sanctions. That appeal came to an end on June 30, 2004, when a federal appeals court
ruled that the 2001 settlement satisfied the legal requirements for addressing Microsoft’s
violations of antitrust laws. By that time,, when a federal appeals court ruled that the 2001
settlement satisfied the legal requirements for addressing Microsoft’s violations of antitrust laws.
By that time,, when a federal appeals court ruled that the 2001 settlement satisfied the legal
requirements for addressing Microsoft’s violations of antitrust laws. By that time, Microsoft had
settled several suits with other states and companies and had paid a total of $1.5 billion to these
parties.
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Microsoft’s monopoly woes were not quite over, however. In 1997, the European Union’s
“Competition Commissioner” had announced that the European Union was investigating
allegations that Microsoft had illegally used its Windows monopoly power to try to establish a
new monopoly in the server market by refusing to share its Windows application programming
interface with companies making software for servers (servers are computers that connect several
other computers together). If other companies are not given the Windows application
programming interfaces, they cannot write server programs that can smoothly connect computers
running Windows. Since only Microsoft had full access to its Windows application programming
interface, only Microsoft would be able to write server programs for Windows computers,
thereby giving it a new monopoly in the server market.
In 2000, the European Commission expanded its investigation to look into how Microsoft
had bundled its Windows Media Player together with the company’s new Widows 2000
operating system. Because all buyers of Windows 2000already had Microsoft’s Digital Media
Player installed on their computers, they were not likely to buy a competitor’s digital media
player. In this way, suggested the commission, Microsoft would gain a new monopoly in the
market for digital media players.
In April 2004, the European Commission issued its final ruling on its investigations. It
concluded that “Microsoft Corporation broke European Union competition law by leveraging its
near monopoly in the market for PC operating systems onto the markets….for servers…and for
media players.” The commission fined Microsoft 497 million euros (equivalent to about $613
million) and ordered it (1) to disclose to competitors the interface required for their server
software to work with Windows computers and (2) to offer a version of Windows without
Microsoft’s own Digital Media Player.
Microsoft immediately appealed this ruling to the European Court of First Instance. In
addition, it asked that the second order be suspended until the European Court of First instance
had ruled on its appeal. In June 2004, the European Commission agreed that until the court ruled
on the appeal, Microsoft did not have to offer a version of Windows without its Digital Media
Player. Experts on European law said the appeal could take several years.
Meanwhile, some government had stopped purchasing Windows and had instead adopted
Linux, a free “open source” operating system. Among these were Italy, Germany, Great Britain,
France, India, South Korea, China, Brazil and South Africa. Several Companies, including
Amazon.com, FedEx, and Google, had moved to Linux. A study by Forrester Research found
that 72 percent of companies it surveyed were increasing their use of Linux, and over half of
them were planning to replace Windows with Linux.
Questions
1. Identify the behaviors that you think are ethically questionable in the history of Microsoft.
Evaluate the ethics of these behaviors.
2. What characteristics of the market for operating systems do you think created the monopoly
market that Microsoft’s operating system enjoyed? Evaluate this market in terms of
utilitarianism, rights, and justice (your analysis should make use of the textbook’s discussion
of the effects of monopoly markets on the utility of participants in the market, on the moral
rights of participants in the market, and on the distribution of benefits and burdens among
participants in the market), giving explicit examples from the operating systems industry to
illustrate your points.
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3. In your view, should the government have sued Microsoft for violation of the antitrust laws?
In your view, was Judge Jackson’s order that Microsoft be broken into two companies fair to
Microsoft? Was Judge Kollar-Kotelly’s November 1, 2004 decision fair? Was the April
2004 decision of the European Commission fair to Microsoft? Explain your answers.
4. Who, if anyone, is harmed by the kind of market that Microsoft’s operating system has
enjoyed? Explain your answer. What kind of public policies, if any, should we have to deal
with industries like the operating system industry?
Case - 3
Gas or Grouse?
The Pinedale Mesa (sometime called the Pinedale Anticline) is a 40-mile-long mesa extending
north and south along the eastern side of Wyoming’s Green River Basin, an area that is famous
as the gateway to the hunting, fishing, and hiking treasures of the Bridger-Teton wilderness. The
city of Pinedale sits below the mesa, a short distance from its northern end, surrounded by
hundreds of recently drilled wells ceaselessly pumping natural gas from the vast pockets that are
buried underneath the long mesa. Questar Corporation, an energy company with assets valued at
about $4 billion, is the main developer of the gas wells around the city and up on the mesa
overlooking the city. Occasionally elk, mule deer, pronghorn antelope, and other wildlife,
including the imperiled greater sage grouse, descend from their habitats atop the mesa and
gingerly make their way around and between the Questar wells around Pinedale. Not
surprisingly, environmentalists are at war with Questar, whose expanding operations are
increasingly encroaching on the wildlife habitat that lies atop the mesa. Yet the mesa is a
desperately needed resource that provides the nation with a clean and cheap source of energy.
Headquartered in Salt Like City, Questar corporation drilled its first successful test well on
the pinedale Mesa in 1998. Extracting the gas under the mesa was not feasible earlier because the
gas was trapped in tightly packed sandstone that prevented it from flowing to the wills and no
one knew how to get it out. it was not until the mid-1990s that the industry developed techniques
for fracturing the sandstone and freeing the gas. Full-scale drilling had to await the completion of
an environmental impact statement, which the Bureau of Land Management (BLM) finished in
mid-2000 when it approved drilling up to 900 wells on federal lands sitting on top of the
Pinedale Mesa. By the beginning of 2004, Questar had drilled 76 wells on the 14,800 acres it
leased from the federal government and the Wyoming state government and had plans to
eventually drill at least 400 more wells. Energy experts welcome the new supply of natural gas,
which, because of its simple molecular structure (CH4), burns much more cleanly than any other
fossil fuel such as coal, diesel oil, or gasoline. Moreover, because natural gas in extracted in the
United States, its use reduced U.S. reliance on foreign energy supplies. Businesses in and around
Pinedale also welcomed the drilling activity, which brought numerous benefits, including jobs,
increased tax revenues, and a booming local economy. Wyoming’s state government likewise
supported the activity since 60 percent of the state budget is based on royalties the state receives
from coal, gas, and oil operations.
Questar’s wells on the mesa averaged 13,000 feet deep and cost $3.6 million each,
depending on the amount of fracturing that had to be done.1 Drilling a well typically required
clearing and leveling a 2- to 4- acre “pad” to support the drilling rig and other equipment. One or
two wells could be drilled at each pad. Access road had to be run to the pad, and the well had to
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be connected to a network of pipes that drew the gas from the wells and carried it to where it
could be stored and distributed. Each well produced waste liquids that had to be stored in tanks at
the pad and periodically hauled away on tanker trucks.
The BLM, however, imposed several restrictions on Questar’s operations on the mesa.
Large areas of the mesa provide habitat for mule deer, pronghorn sheep, sage grouse, and other
species, and the BLM imposed drilling rules that were designed to protect the wildlife species
living on the mesa. Chief among these was the sage grouse.
The sage grouse is a colorful bird that today survives only in scattered pocket in 11 states.
The grouse, which lives at elevations of 4,000 to 9,000 feet and is dependent on increasingly rare
old-growth sagebrush for food and to screen itself from predators, is extremely sensitive to
human activity. Houses, telephone poles, or fences can draw hawks and ravens, which prey on
the ground-nesting grouse. It is estimated that 200 years ago the birds-known for their distinctive
spring “strutting” mating dance-numbered 2 million and were common across the western United
States. By the 1970s, their numbers had fallen to about 400,000. a study completed in June 2004
by the Western Association of Fish and Wildlife Agencies concluded that there were only
between 140,000 and 250,000 of the birds left and that “we are not optimistic about the future.”
The dramatic decline on their number was blamed primarily on the destruction of 50 percent of
their sage brush nesting and mating grounds (called leks), which in turn was blamed on livestock
grazing, new home construction, fires, and the expanding acreage being given over to gas
drilling and other mining activities. Biologists believe that if its sagebrush habitats are not
protected, the bird will be so reduced in number by 2050 that it will never recover. According to
Pat Deibert, a U.S. Fish and Wildlife Service biologist, “they need large stands of unbroken
sagebrush” and anything that breaks up those stands such as roads, pipelines, or houses, effects
them.2
In order to protect the sage grouse, whose last robust population had nested for thousands
of years on the ideal sagebrush fields up on the mesa, the BLM required that Questar’s roads,
wells, and other structures had to be located a quarter mile or more from grouse breeding
grounds, and at least 2 miles from nesting areas during breeding season. Some studies, however,
conclude that these protections were not sufficient to arrest the decline in the grouse population.
As wells proliferated in the area, they were increasingly taking up land on which the grouse
foraged and nested and were disturbing the sensitive birds. Conservationists said that the BLM
should increase the quarter-mile buffer area around the grouse breeding grounds to at least 2-
mile buffers.
In May 2004, the U.S. Fish and Wildlife Service announced that it would being the process
of studying whether the sage grouse should be categorized as an endangered species, which
would bring it under the protection of the Endangered Species Act, something conservationists
had been urging the Fish and Wildlife Service to do since 2000. Questar and other gas, oil, and
mining companies adamantly opposed having the grouse listed as an endangered species because
once this was done, large areas of federal land would be off-limits to drilling, miming, and
development. Since 80 percent of Wyoming is considered sage grouse habitat, including much of
the Pinedale Mesa, Questar’s drilling plans would be severely compromised.
Questar and other companies formed a coalition-the Partnership for the West-to lobby the
Bush administration to keep the grouse off the endangered species list. Led by Jim Sims, a
former communication director for President George W. Bush’s energy Task Force, the coalition
established a website where they called on members to lobby “key administration players in
Washington” and to “unleash grass-roots opposition to a listing, thus providing some cover to the
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political leadership at Department of Interior and throughout the administration.” The coalition
also suggested “funding scientific studies” designed to show that the sage grouse was not
endangered. According to Sims, the attempt to categorize the grouse as endangered species was
spearheaded by “environmental extremists who have converged on the American west in an
effort to stop virtually all economic growth and development. They want to restrict business and
industry at every turn. They want to put our Western lands of –limits to all of us.”3 Dru Bower,
vice president of the petroleum Association of Wyoming, said,”[endangered species] listings are
not good for the oil and gas industry, so anything we can do to prevent a species from being
listed is good for the industry. If the sage grouse is listed, it would have a dramatic effect on oil
and gas development in the state of Wyoming.”4
The sage grouse was not the only species affected by Questar’s drilling operations. The
gas fields to which Questar held drilling rights was an area 8 miles long and 3 miles wide,
located on the northern end of the mesa. This property was located in the middle of the winter
range used by mule deer, elk, moose, and pronghorn antelope, some of which migrate to the
mesa area from as far away as the Grand Teton National Park 170 miles to the north.Migration
studies conducted between 1998 and 2001reveled that the pronghorn antelope herds make one of
the longest annual migration among North American big game animals.the area around pinedale
is laced with migration corridors used by thousand of mule deer and pronghorn every fall as they
make their way south to their way south to their winter grounds on the mesa and the Green River
Basin. Traffic on highway 191 which cuts across some of the migration corridors sometimes has
to be stopped to let bunched-up pronghorn herds pass.5 Environmentalists feared that if the
animals were prevented from reaching their winter ranges or if the winter ranges became
inhospitable, the large herds would wither and die off.
Unfortunately, drilling operations create a great deal of noise and require the constant movement
of many truck and other large machines, all of which can severely impact animals during the
winter when they are already physically stressed and vulnerable due to their low calorie intake.
Some studies had suggested that even the mere presence of humans disturbed the animals and led
them to avoid an area. Consequently, the BLM required Questar to cease all drilling operations
on the mesa each winter from November 15 to May 1. in fact, to protect the animals the led them
to avoid an area. Consequently , the BLM required Questar to cease all drilling operation on the
mesa each winter from November 15 to May 1. In fact, to protect the animals the BLM
prohibited all persons, whether on foot or on automobile, from venturing into the area during
winter. The BLM, however, made an exception for Questar truck and personnel who had to
continue to haul off liquid wastes from wells that had already been drilled and that continued to
operate during the winter (the winter moratorium prohibited only drilling operations, and
completed wells were allowed to continue to pump gas throughout the year).
Being forced to stop drilling operations during the winter months was extremely frustrating and
costly to Questar. Drilling crew had to be laid off at the beginning of winter, and new crews had
to be hired and retrained every spring. Every fall the company had to pack up several tons of
equipment, drilling rigs, and trucks and move them down from the mesa. Because of seasonal
interruption in its drilling schedule, the full development of its oil fields was projected to take 18
years, much longer than it wanted. In 2004, Questar submitted a proposal to the Bureau of Land
Management. Questar proposed to invest in a new kind of drilling rig that allowed up to 16wells
to be dug from a single pad, instead of the traditional 1or2. the new technology (called
directional drilling) aimed the drill underground at a slanted angel away from the pad-like the
outstretched tentacles on an octopus-multiple distant locations could be tapped by several wells
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branching out from a single pad. This minimized the land occupied by the wells: while
traditional drilling required 16 separate 2-4 acre pads to support 16 wells, the new “directional
drilling” technology allowed a single pad to hold 16 wells. The technology also reduced the
number of required road ways and distribution pipes since a single access road and pipe could
now service the same number of wells that traditionally required 16 different road and 16
different pipes. Questar also proposed that instead of carrying liquid wastes away from operating
wells on noisy tanker trucks, the company would build a second pipe system that would pump
liquid wastes away automatically. These innovations, Questar pointed out, would substantially
reduce any harmful impact that drilling and pumping had on the wildlife inhabiting the mesa.
Using the new technology for the 400 additional wells the company planned to drill would
require 61 pads instead of 150, and the pads would occupy 533 acres instead of 1,474.
The new directional drilling technology added about $500,000 to the cost of each well and
required investing in several new drilling rigs. The added cost for the 400 additional wells
Questar noted, however, that “the company anticipates that it can justify the extra cost if it can
drill and complete all the wells on a pad in one continuous operation” that continued through the
winter.6 if the company was allowed to drill continuously through the winter, it would be able to
finish drilling all its wells in 9 years instead of 18, thereby almost doubling the company’s
revenues from the project over those 9 years. This acceleration in its revenues, coupled with
other saving resulting from putting 16 wells on each pad, would enable it to justify the added
costs of directional drilling. In short, the company would invest in the new technology that
reduced the impact on wildlife, but only if it was allowed to drill on the mesa during the winter
months.
Although environmentalists welcomed the company’s willingness to invest in directional
drilling, the y strongly opposed allowing the company to operate on the mesa during the winter
when mule deer and antelope were there foraging for food and struggling to survive. The Upper
Green River Valley Coalition of environmental group, issued a statement that read: “The
company should be lauded for using directional drilling, but technological improvement should
not come at the sacrifice of important safeguards for Wyomings’s wildlife heritage.” To allow
the company to test the feasibility of directional drilling and to study its effects on wintering deer
herds, the Bureau of Land Management allowed Questar to drill wells at a single pad through the
winter of 2002-2003 and again through the winter of 2003-2004. the 5-year study would
continue until 2007, and Questar hoped to be permitted limited drilling on the mesa during
winter until then. In a preliminary report on the study, the Bureau of Land Management said
there was “no conclusive data to indicate quantifiable, adverse effects to deer” from the drilling.
The Upper Green River Vslley Coslition, however, sued the bureau for failing to adhere to its
own rules when it allowed Questar and other companies to drill on mule deer range on the mesa
during winter and for failing to conduct an analysis of the potential impact before granting the
permits, as required by the National Environmental Policy Act. As of this writing, the suit has
not been resolved.
Question
1. What are the systemic, corporate, and individual issues raised in this case?
2. How should wildlife species like grouse or deer be valued, and how should that value be
balanced against
the economic interests of the of company like Questar?
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3. In light of the U.S. economy’s dependence on oil, and in light of the environmental impact of
Questar drilling operation, is Questar morally obligated to cease its drilling operation
on the Pinedale Mesa? Explain
4. What, if anything, should Questar be doing differently?
5. In your view, have the environmental interest groups identified in the case behaved ethically?
`
Case - 4
Becton Dickinson and Needle Sticks
During the 1990s, the AIDS epidemic posed peculiarly acute dilemmas for health workers. After
routinely removing an intravenous system, drawing blood, or delivering an injection to an AIDS
patient, nurses could easily stick themselves with the needle they were using. “Rarely a day goes
by in any large hospital where a needle stick incident is not reported. “ In fact, needlestick
injuries accounted for about 80 percent of reported occupational exposure to the AIDS virus
among health care workers.2 It was conservatively estimated in 1991 that about 64 health care
workers were infected with the AIDS virus each year as a result of needlestick injuries.3
AIDS was not the only risk posed by needlestick injuries. Hepatitis C, and other lethal diseases
were also being contracted through accidental needlesticks. In 1990, the Center for Disease
Control (CDC) estimated that at least 12,000 health care workers were annually exposed to blood
contaminated with the hepatitis B virus, and of these 250 died as a consequence.4 Because the
hepatitis C virus had been identified only in 1988, estimates for infection rates of health care
workers were still guesswork but were estimated by some observers to be around 9,600 per year.
In addition to AIDS hepatitis B, and hepatitis C, needlestick injuries can also transmit numerous
viral, bacterial, fungal, and parasitic infection, as well as toxic drugs or other agents that are
delivered through a syringe and needle. The cost of all such injuries was estimated at $400
million to $1 billion a year.5
Several agencies stepped in to set guidelines for nurses, including the Occupational Safety and
Health Administration (OSHA). On December 6, 1991, OSHA required hospitals and other
employers of health workers to (a) make sharps containers (safe needle containers) available to
workers, (b) prohibit the practice of recapping needle by holding the cap in one hand inserting
the needle with the other, and (c) provide information and training on needlestick prevention and
training on needlestick prevention to employees.6
The usefulness of these guidelines was disputed.7 Nurses worked in high-stress emergency
situations requiring quick action, and they were often pressed for time both because of the large
number of patients they cared for and the highly variable needs and demands of these patients. In
such workplace environments, it was difficult to adhere to the guidelines recommended by the
agencies. For example, a high-risk source of needlesticks is the technique of replacing the cap on
a needle (after it has been used) by holding the cap in one hand and inserting the needle into the
cap with the other hand. OSHA guidelines warned against this tow-handed technique of
recapping and recommended instead that the cap be placed on a surface and the nurse use a one-
handed “spearing” technique to replace the cap. However, nurses were often pressed for time
and, knowing that carrying an exposed contaminated needle is extremely dangerous, yet seeing
no ready surface on which to place the needle cap, they would recap the needle using the two-
handed technique.
Several analysts suggested that the nurse’s work environment made it unlikely that
needlesticks would be prevented through mere guidelines. Dr. Janine Jaegger, an expert on
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needlestick injuries, argued that “trying to teach health care workers to use a hazardous device
safely is the equivalent of trying to teach someone how to drive a defective automobile safely….
Until now the focus has been on the health care worker, with finger wagging at mistakes, rather
than focusing on the hazardous product design…. We need a whole new array of devices in
which safety is an integral part of the design.”8 The Department of Labor and Department of
Health and Human Services in a joint advisory agreed that “engineering controls should be used
as the primary method to reduce worker exposure to harmful substances.”9
The risk of contracting life-threatening diseases by the use of needles and syringes in health
care setting had been well documented since the early 1980s. articles in medical journals in 1980
and 1981, for example, reported on the “problem” of “needle stick and puncture wounds” among
health care workers.10 Several articles in 1983 reported on the growing risk of injuries hospital
workers were sustaining from needles and sharp objects.11 Articles in 1984 and 1985 were
sounding higher-pitched alarms on the growing number of hepatitis Band AIDS cases resulting
from needlesticks.
About 70 percent of all the needles and syringes used by U.S. health care workers were
manufactured by Becton Dickinson. Despite the emerging crisis, Becton Dickinson decided not
to change the design of its needles and syringes during the early 1980s. To offer a new design
would not only require major engineering, retooling, and marketing investments but would
mean offering a new product that would compete with its flagship product, the standard syringe.
According to Robert Stathopulos, who was an engineer at Becton Dickinson from 1972 to 1986,
the company wanted “to minimize the capital outlay” on any new device.12 During most of the
1980s, therefore, Becton Dickinson opted to do no more than include in each box of needles
syringes an insert warning of the danger of needlesticks and of the dangers of two-handed
recapping.
On December 23, 1986, the U.S. Patent office issued patent number 4,631,057 to Norma
Sampson, a nurse, and Charles B. Mitchell, an engineer, for a syringe with a tube surrounding
the body of the syringe that could be pulled down to cover and protect the needle on the syringe.
It was Sampson and Mitchell’s assessment that their invention was the most effective, easily
usable, and easily manufactured device capable of protecting users from needlesticks,
particularly in “emergency periods or other time of high stress”13 Unlike other syringe designs,
theirs was shaped and sized like a standard syringe so nurses already familiar with standard
syringe designs would have little difficulty adapting to it.
The year after Sampson and Mitchell patented their syringe, Becton Dickinson purchased
from them an exclusive license to manufacture it. A few months later, Becton Dickinson began
filed tests of earl models of the syringe using a 3-cc model. Nurses and hospital personnel were
enthusiastic when show the product. However they warned that if the company priced the
product too high, hospital, with pressures on their budgets rising, could not buy the safety. With
concerns about AIDS rising, the company decided to market the product.
In 1988, with the filed test completed, Becton Dickinson had to decide which syringe would
be market with the protective sleeves. Sleeves could be put on all of the major syringe sizes,
including 1-cc, 3-cc, 5-cc, and 10-cc syringes. However, the company decided to market only a
3-cc version of the protective sleeve. The 3-cc syringes accounted for about half of all syringes
used, although the larger size-5-cc and 10-cc syringes-were preferred by nurses when drawing
blood.
This 3-cc syringe was marketed in 1988 under the trademarked name Safety-Lok Syringe
and sold to hospitals and doctors’ offices for between 50 and 75 cent, a price that Becton
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Dickinson characterized as a “premium” price. By 1991, the company had dropped the price to
26 cents a unit. At the time, a regular syringe without any protective device was priced at 8 cents
a unit and cost 4 cents to make. Information about the cost of manufacturing the new safety
syringe was proprietary, but an educated estimate would put the costs of manufacturing each
Safety-Lok syringe in 1991 at 13 to 20 cents. 14
The difference between the price of a standard syringe and the “premium” price of the
safety syringe was an obstacle for hospital buyers. To switch to the new safety syringe would
increase the hospital’s costs for 3-cc syringes by a factor of 3to 7. An equally important
impediment to adoption was the fact that the syringe was available in only one 3-cc size, and so,
as one study suggested, it had “limited applications.”15 Hospitals are reluctant to adopt, and adapt
to, a product that is not available for the whole range of applications the hospital must confront.
In particular, hospitals often needed the larger 5-cc and 10-cc sizes to draw blood, and Becton
Dickinson had not made these available with a sleeve.
In 1992, a nurse, Maryann Rockwood (her name is disguised to protect her privacy), was
working in a San Diego, California, clinic that served AIDS patients. That day she used a Becton
Dickinson standard 5-cc syringe and needle to draw blood from a patient known to be infected
with AIDS. After drawing the blood, she transferred the AIDS-contaminated blood to a sterile
test tube called a Vacutainer tub by sticking the through the rubber stopper of the test tube, which
she was holding with her other hand. She accidently pricked her finger with the contaminated
needle. A short time later, she was diagnosed as HIV positive.
Maryann Rockwood sued Becton Dickinson, alleging that, because it alone had an
exclusive right to Sampson and Mitchell’s patented design, the company had a duty to provide
the safety syringe in all size and that by withholding other size from the market it had
contributed to her injury. Another contributing factor, she claimed, was the premium price
Becton Dickinson had put on its product, which prevented employers like hers from purchasing
even those size that Becton Dickinson did make. Becton Dickinson quietly settled this and
several other, similar cases out of court for undisclosed sums.
By 1992, OSHA had finally required that hospitals and clinics give their workers free
hepatitis B vaccines and provide safe needle disposal boxes, protective clothing, gloves, and
masks. The Food and Drug Administration (FDA) also was considering requiring that employers
phase in the use of safety needles to prevent needlesticks, such as the new self-sheathing syringes
that Becton Dickinson was now providing. If the FDA or OSHA required safety syringes and
needles, however, this would hurt the U.S. market for Becton Dickinson’s standard syringes and
needles, forcing in to invest heavily in new manufacturing equipment and a new technology.
Becton Dickinson, therefore, sent its marketing director, Gary Cohen, and two other top
executives to Washington, D.C., to convey privately to government officials that the company
strongly opposed a safety needle requirement and that the matter should be left to “the market.”
The FDA subsequently decided not to require hospitals to buy safety needles.16
The following year, a major competitor of Becton Dickinson announced that it was
planning to market a safety syringe based on a new patent that was remarkably like Becton
Dickinson’s. Unlike Becton Dickinson, however, the competitor indicated that it would market
its safety device in all sizes and that it would be priced well below what Becton Dickinson had
been charging. Shortly after the announcement, Becton Dickinson declared that it, too, had
decided to provide its Safety-Lok syringe in the full range of common syringe sizes. Becton
Dickinson now proclaimed itself the “leader” in the safety syringe market.
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However, in 1994, the most trusted evaluator of medical devices, a nonprofit group named
ECIR, issued a report stating that after testing it had determined that although Becton
Dickinson’s safety-Lok syringe was safe that Becton Dickinson’s own standard syringe,
nevertheless the safety-Lok “offers poor needlesticks protection.” The following year this low
evaluation of the safety –Lok syringe was reinforced by the U.S. veteran’s Administration, which
ranked the Safety – Lok Syringe below the safety products of other manufacturers.
The technology for safety needles took a giant step forward in 1998 when Retractable
Technologies,
Inc., unveiled a new safety syringe that rendered needlesticks a virtual impossibility. The new
safety, invented by Thomas Shaw, a passionate engineer and founder of Retractable
Technologies, featured a syringe with a needle attached to an internal spring that automatically
pulled the needle into the barrel of the syringe after it was used. When the plunger of the syringe
was pushed all the way in, the needle snapped back into the syringe faster then the eye could see.
Called the vanishpoint syringe, the new safety syringe required only one hand to operate and was
acclaimed by nursing groups and doctors. Unfortunately, it was difficult for Retractable to sell its
new automatic syringe because of a new phenomenon that hand emerged in the medical industry.
During the 1990s, hospitals and clinics had attempted to cut costs by reorganizing
themselves around a few large distributors called Group Purchasing Organizations or GPOs. A
GPO is an agent that negotiates prices for medical supplies on behalf of its member hospitals.
Hospitals became members of the GPO by agreeing to buy 85 percent to 95 percent of their
medical supplies from the manufacturers designated by the GPO, and their pooled buying power
then enabled the GPO to negotiate lower prices for them. The two largest GPOs were Premier, a
GPO with 1,700 member hospitals, and Novation, a GPO with 650 member hospitals. GPOs
were accused, however, of being prey to “conflicts of interest” because they were paid not by the
hospitals for whom they worked, but by the manufacturers with whom they negotiated prices
(the GPO received from each manufacturer a negotiated percentage of the total purchases its
member companies made from that manufacturer). Critics claimed that manufacturers of medical
products in effect were paying off GPOs to get access to the GPO member hospitals. In fact,
critics alleged, GPOs such as Premier and Novation no longer tried to bring their member
hospitals the best medical products nor the lowest-priced products. Instead, critics alleged, GPOs
chose manufacturers for their members based on how much a manufacturer was willing to pay
the GPO. The more money (the higher percentage of sales) a manufacturer gave the GPO, the
more willing the GPO was to put that manufacturer on the list of manufacturers from which its
member hospitals had to buy their medical supplies. 17
When Retractable tried to sell its new syringe, which was recognized as the best safety
syringe on the market and as the only safety syringe capable of completely eliminating all
needlesticks in a nursing environment, it found itself blocked from doing so. In 1996, Becton
Dickinson had gotten Premier GPO to sign an exclusive, 7 ½-year, $1.8 billion deal that required
Premier’s member hospitals to buy at least 90 percent of their syringes and needles from Becton
Dickinson. Around the same time, Becton Dickinson had signed a similar deal with Novation
that required its member hospitals to buy at least 95 percent of their syringes and needles from
Becton Dickinson. Because hospitals were now locked into buying their syringes and needles
from Becton Dickinson, or suffer substantial financial penalties, they turned away Retractable’s
salespeople, even when their own nursing recommended Retractable’s safety product better as
and more cost-effective than Becton Dickinson’s.
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Although Retractable’s safety syringe was almost double the cost of Becton Dickinson’s,
hospitals that adopted Retractable’s syringe would save money over the long run because they
would not have to pay any of the substantial costs associated with having their workers suffer
frequent needlesticks and needlestick infections. The Center for Disease Control (CDC)
estimated that each needlestick in which the worker was not infected by any disease cost a
hospital as much as $2,000 for testing, treatment, counseling, medical costs, and lost wages, plus
unmeasurable emotional trauma, anxiety, and abstention from sexual intercourse for up to a year.
Those needlesticks in which the victim was infected by HIV, hepatitis B or C, or some other,
potentially lethal infection, cost a hospital between $500,000 to more than $1 million and cost
the victim anxiety, sickness from drug therapy, and, potentially, life itself. Retractable’s syringe
completely eliminated all of these costs. Because all of the other syringes then on the market,
including Becton Dickinson’s Safety-Lok, still allowed some needlesticks to occur, they could
not completely eliminate all the costs associated with needlesticks and so were not as cost-
effective. (A CDC study found that Becton Dickinson’s Safety-Lok, when tested by hospital
health workers in three cities from 1993 to 1995, had cut needle-stick injuries only from 4 per
100,000 injections down to 3.1 per 100,000 injections, a reduction of only 23 percent, the worst
performance of all the safety devices tested.) An econometric study commissioned by
Retractable proved that its safety syringe was the most cost effective syringe on the market.
In October 1999, ECRI, the nation’s most respected laboratory for testing medical
products, rated Becton Dickinson’s Safety-Lok syringe “unacceptable” as a safety syringe,
saying it might actually cause an increase in needlesticks because it required two hands to use it
and one hand might accidentally touch the needle. It simultaneously gave Retractable’s
Vanishpoint syringe its highest rating as a safety syringe, the only safety syringe to achieve this
highest level. Becton Dickinson objected strenuously to the low rating of its own syringe, and in
2001, the testing lab raised the rating for the safety-Lok a notch to “not recommended.”
Retractable’s Vanishpoint syringe, however, continued to receive the highest rating. In spite of
being recognized as the best and most cost-effective technology for protecting health care
workers from being infacted through needlesticks, Retractable still found itself blocked out of the
market by the long-term deals that Becton Dickinson had negotiated with the major GPOs.18
In1999, California became the first state to require its hospitals to provide safety syringes to
its workers. Then, in November 2000, the Needlestick safety and Prevention Act was signed into
low. The act required the use of safety syringes in hospitals and doctor’s offices. In 2001, OSHA
incorporated the provisions of the Needlestick Safety and Prevention Act, finally requiring
hospitals and employers to use safety syringes and significantly expanding the market for safety
syringes, a development that is expected to bring lower prices. None of this legislation required a
specific type or brand of syringe and Becton Dickinson’s safety devices were stocked by most
GPO member hospitals.
Continuing to find itself locked out of the market by Becton Dickinson’s contracts with
Premier and Novation, Retractable sued Premier, Novation and Becton Dickinson in federal
court alleging that they violated antitrust laws and harmed consumers and numerous health care
workers by using the GPO system to monopolize the safety needle market.19 In 2003, Premier
and Novation settled with Retractable out of court, agreeing to henceforth allow its member
hospitals to purchase Retractable’s safety syringes when they wanted. In 2004, Becton Dickinson
also settled out of court, agreeing to pay Retractable $ 100 million in compensation for the
damage Becton Dickinson inflicted on Retractable. During the 6 years that Becton Dickinson’s
contracts prevented Retractable and other manufacturers from selling their safety needles to
23. The Indian Institute Of Business Management & Studies
Subject: Business Ethics. Marks: 100
hospitals and clinics, thousands of health workers continued to be infected by needlesticks each
year.
Questions
1. In your judgment, did Becton Dickinson have an obligation to provide the safety syringe in
all its sizes in 1991? Explain your position, using the materials from this chapter and the
principles of utilitarianism, rights, justice, and caring.
2. Should manufacturers be held liable for failing to market all the products for which they
hold exclusive patents when someone’s injury would have been avoided if they had
marketed those products? Explain your answer.
3. In your judgment, who was morally responsible for Maryann Rockwood’s accidental
needlestick: Maryann Rockwood? The clinic that employed her? The government agencies
that merely issued guidelines? Becton Dickinson?
4. Evaluate the ethics of Becton Dickinson’s use of the GPO system in the late 1990s. Are the
GPO’s monopolies? Are they ethical? Explain.