How have groups been able to remove barriers to access to essential medicines, medical treatment and medical information created by intellectual property?
What approaches have worked? What has not worked? What approaches could be made strong? How could we make these approaches more effective? How could we increase collaboration and coordination between groups working on similar issues?
Share your experiences, stories, challenges, and ideas by adding a new comment to this discussion thread or replying to an existing comment!
The WTO Doha Declaration on TRIPS (Agreement on Trade-Related Aspects of Intellectual Property Rights) and Public Health of 2001 recognises that WTO members are entitled to issue compulsory licences for the manufacture of generic versions of patented pharmaceuticals where necessary to meet their public health needs. A subsequent 2005 "paragraph 6" protocol amends TRIPS to allow countries without domestic manufacturing capacity to import such generic medicines. These measures would not have succeeded without activism, so this is a win.
On the other hand, the procedures for the use of the TRIPS protocol have been too complicated for most developing countries to use (see this report). Exactly the same applies to the Appendix to the Berne Convention on copyright, which was intended to allow similar flexibilities to developing countries for the reproduction of copyright works, but have been very seldom used because they are too cumbersome.
So we have to consider whether this has really been a win or not... how can we prevent the introduction of so many compromises into such efforts that they are effectively sabotaged?
In fact there are some TRIPS flexibilities that can be used in the interest of public Health, but there is an ongoing battle to actually exercise these safeguards in order to obtain drugs at more affordable prices.
In developing countries, there are lot of civil society groups engaged in this battle, trying to influence lawmakers and politicians on issues like use of flexibilities, e.g. compulsory licensing, law bills monitoring and competition, i.e. the entry of generic competitiors in the market. But in the other hand we have big transnational companies pressuring for mantaining their monopolies, which enables high prices practices and other kinds of abuses.
Our experience in Brazil proves that it is possible to mitigate the adverse effects of the rights confered to patente holders on public health policies. As an example, in 2006 the attempted to capitalize on administrative channels to prevent the granting of undue patents for essential medecines. The group presented a pre-grant opposition for a patent aplication made by Gilead for its Viread ® medication (scientific name: tenofovir), arguing that there was no inventiveness. The patent was denied in Brazil and in 2009 the same happened in India, as result of collaboration between GTPI and an Indian NGO
OBS: pre grant opposition are a provision contained in Brazilian Intellectual property law that permits any interested parties to submit documents and information to assist in the examination of patent applications being analyzed.
However, in documents released recently by Wikileaks it is apparent that this civil society victory was closely observed by US ambassadors. The decision unfavorable for Gilead became occasion to put some ‘soft’ pressure over brazilian officials, as we can see in this fragment:
“Gilead reps suggested that the arrival of a new Ambassador might afford new opportunities to discuss the case with high-level GOB (Gov. of Brazil) interlocutors. They repeated, however, that they intend to keep their response positive and non-threatening and that USG engagement should simply convey that the case "has not gone unnoticed."”
This kind of pressure is really decisive and comes not only on diplomatic communications. A recent story published by a Brazilian newspaper shows that some politicians received money from Interfarma[1] during last electoral campaign. According to Brazilian electoral law as a class organization Interfarma is not allowed to make this kind of donation. Besides theses strategies to shorten A2M, we have also some Free Trade Agreements, a way to push into developing countries TRIPS-plus provisions, such as the one being negotiated between European Union and India, and ACTA – an Agreement which is being negotiated out of all the possible institutionalized spaces, also imposing provisions that goes beyond TRIPS requirements and represents serious threats to production of affordable life-saving drugs.
Only with a really strong cooperation we can face this scenario and avoid that IPR overlaps people’s basic needs, guaranteed by several Human Rights Treaties
[1] Interfarma represents interests of big pharmaceutical companies in Brazil
One of the main mechanisms that is used to apply such pressure to developing countries is the United States Trade Representative's (USTR) Special 301 Report. This is a report issued every year in which the United States rates how strong the standards of intellectual property protection and enforcement are in other countries around the world. In the past, countries have been rated poorly even though they are in full compliance with their international obligations under TRIPS. For example, countries have been criticised for exercising their right to issue compulsory patent licences over pharmaceuticals for public health reasons.
This hard-line stance of the USTR has been widely criticised, and so in the 2010 edition of the report it retreated from this position slightly, affirming the rights of developing countries to avail themselves of TRIPS flexibities. Yet in other areas, the 301 Report continues to push a TRIPS-plus level of IP protection and enforcement, for example criticising countries for failing to criminalise the use of camcorders in movie theatres (which is not a requirement under any international instrument, other than a few bilateral trade agreements drafted by the United States itself).
In response to the one-sidedness of the Special 301 Report, Consumers International has for the last couple of years put out an IP Watchlist in which we turn the analysis around - looking at which countries have the fairest IP laws and enforcement practices for consumers, rather than the strongest for rights holders. In this Watchlist, some of the countries rated worst by the USTR are rated best (such as India), and some of the best are rated worst (such as the United Kingdom). The United States actually rates fairly well, because it has much fairer laws for its own citizens than those it attempts to force upon others.
While I can, let me just note that we are seeking a new volunteer to updated the United States Watchlist report for 2011. The deadline is 28 February 2010. If you are interested in helping, please do let me know. You can contact me by clicking on my username on this site and filling in the contact form.
A few thoughts on these discussions - first, I have covered the special 301 report since the 1990s (for Inside U.S. Trade) and have come to realize that special 301 is a sort of myth, has almost no teeth, no legal impact, and is little more than a wishlist for the US govt in its bilateral trade relations. If journalists (like me) and activists, and especially other governments, ignored this list, most of its impact would vanish, in my opinion. It is a useful roadmap or agenda of bilateral topics of interest to the US, but little more. The EU, Brazil and others also have had their lists of trade violations they accuse the US of committing, including IPRs. Washington trade journalists still will write whole stories about what other governments think based on US industry sources. And they will still write special 301 with a kind of breathlessness that it does not deserve. With the hype, the special 301 has been so successful as a PR tool that it is regularly held up as a model for other initiatives. Yet if you ask USTR officials if they could challenge the other governments through the WTO on most of the charges or concerns raised in it, they would say no. For instance, Thailand's use of compulsory licensing. The advice I would have to other governments (and the rest of stakeholders) is just ignore special 301. It's a nice tip sheet for what USTR and Commerce officials will come to you to talk about, but it is itself potentially indefensible under international trade rules. The real focus might be on the unilateral trade benefits the US offers to poorer countries, which carry these demands specified in special 301. The IP Watchlist (no affiliation with IP-Watch btw) is a useful tool and may help shift the discussions. But my emphasis is on helping smaller economy governments to see they have a choice in reacting to the threats in the 301 list. I dont think Canada or the EU members are too worried about being on the US watchlist. For them, it is business as usual and a good set of talking points for the next bilateral meeting.
I've found interesting to do a "positive" Watchlist! I've worked until recently in the Brazilian Working Group of Intellectual Property (GTPI - acronym in portuguese) and last year the organization, that is participating of this dialogue, submited a contribution to the Special 301. It would be great if you could get in touch with then to see if they are interested in participating in this Watchlist, especially because an important public health safeguard in currently under heavy attack in Brazil (the Anvisa's [Brazilian FDA] prior consent mechanism). Their website is www.patentes.org.br and further details about the prior consent struggle can be found here http://patentes.org.br/media/file/nota%20anuencia%20ingles_ing_jan11.pdf
Amongst the few tools one is to give a call for Boycott of products of the particular company. In the Indian context Novartis has approached the Supreme Court of India, after having lost the battle in the lower court in the state of Tamil Nadu. Novartis seeks that Section 3(d) of the Indian Patent act be suitable changed.
There has been wide spread global cry against this especially by MSF but inspite of all this Novartis continues with every efforts including bringing in the many TRIPS plus agendas during bilateral trade negotiations. By doing all this Novartis a profit making Swiss profit making company is questioing the very sovereignity of the democratic set up of India!
Given this background several campaign groups in India like People's Health Movement - India (http://phm-india.org/) and All India Drug Action Network (AIDAN) (www.aidanindia.wordpress.com) have launched a boycott campaign:- www.novartisboycott.org.
From
Dr Gopal Dabade
INDIA
Dr. Gopal Dabade,
Thank you for sharing with us the situation in India regarding one large Pharma company - Novartis. I would be interested in learning more about what has been the impact of the 'Novartis Boycott Campaign.' Were you able to get the support of the pharmacies in India? Were you able to get the support of the patients? Do you think that this campaign has pushed Novartis to continue to advertise their Glivec International Patient Assistance Program (GIPAP)? If so, is this a positive change or do you think it is harmful?
Are there other examples of Pharma boycotts? Have they been successful? What has been the impact?
Thank you!
I just wanted to make a note here that there also might be opportunities to leverage health care financing authorities or social responsibility funds. I think that investors should be very wary of investing in companies that are failing to live up to their civic duties.
In his comment in another discussion thread, Ethan described UAEM's successful campaign to create the space (legal and economic space) to allow the generic production of stavudine:
This is a great story that to me, speaks of the importance of really understanding the motivations at play. In any campaign, there is the challenge of changing people's minds - opening up new ways of doing things and new possibilities. This requires an understanding of your target's motivations for doing what they are doing now, and understanding what incentives need to be in place to convince them to change.
New Tactics has a great tactical notebook (tactic-guide) on a similar approach. The notebook is Powerful Persuasion: Combating traditional practices that violate human rights available in English, French, Bangla and Kyrgyz. The context of this notebook is different than the context we are discussing in this dialogue, but what is similar is the way in which both UAEM and the Commission on Human Rights and Administrative Justice (CHRAJ) in Ghana had to persuade their targets to change the way they have been doing things. Campaigns that deal with human rights issues do not always have to take a combative approach. Depending on the context, it can sometimes be more effective to use a more persuasive approach.
With regard to the UAEM story above, I would love to hear more about how UAEM persuaded Bristol Myers-Squibb to allow for the generic production of the medicine. Perhaps, the more we can understand about this kind of persuasion, the more we can find opportunities to use this tactic again and again.
How else have campaigns been able to push for the production of generic drugs? Please share your stories!
In the case of stavudine it was primarily publicity/public shame. At the outset, Doctors Without Borders asked Yale and BMS and was turned down. At that point students got involved with a petition and prepared to hold a rally. In the midst of that activists worked with the discoverer of stavudine to write an op-ed in the New York Times. Following this public airing of their completely unjust actions, they backed down before the rally was needed. In much of our advocacy, we try to use the full arsenal of activists tools starting with a strong, well-researched argument to educate your target but always ready to take further steps to build external support and if necessary direct pressure campaigns. We also regularly work with student organizers from other organizations to do activist training to keep ourselves up on tactics.
Thanks Ethan for sharing this example of the public awareness and public shaming tactic used by Doctors Without Borders to build the pressure on Bristol Myers-Squibb and Yale.
Our New Tactics tactics database provides an example from South Africa - Challenging the government to make defiance of pharmaceutical patent laws legal
This tactics example comes from the Treatment Action Campaign (TAC) in South Africa. It highlights how TAC began importing generic HIV/AIDS drugs in defiance of patent laws to pressure the drug companies to reduce the cost of drugs as well as pressure the South African government to allow the importation of generic versions of patented drugs. The goal of the tactic was to increase access to affordable HIV/AIDS prescription drugs for all South Africans.
Are there other diseases - such as TB or as discussed earlier, types of vaccines - that rise to the level of epidemic where this kind of pressure could be useful? Are the HIV/AIDS drugs in the category of "chemical generics" as discussed by Sara in her post - When is a generic exactly the same? Making this kind of idea much harder to accomplish with "generic biologics"?
Students, such as those that worked with Doctors Without Borders at Yale or many many others who have worked on HIV activism, have had the slight benefit that almost all HIV treatments are small molecule drugs and hence are true generics that can be (relatively) easily copied.
The HPV vaccine could be another place to work on "generic access", particularly if future generations of the medicine are better suited to the developing country context. Activists could demand that manufacturers teach developing country producers how to make it at lower prices. This is comparatively a harder ask then just getting the IP barriers out of the way and allowing the generic to step in. But it may not be impossible.
Good point Jeremy, the special 301 report is another pressure mechanism and Brazil is always in the dark list (We are working on a piece to be presented contesting USTR arguments, in partnership with copyright activists, maybe i can share it later). Congratulations for the IP WATCHLIST, i Just gave a look and it seems to be a very good reference for further discussions (Again, Brazil is not so well ranked...we still got a lot of work to do i guess).
This movement in Índia against Novartis was really strong and inspiring. GTPI made a huge effort to shed light on this case, collecting signatures for a petition “Novartis Drop the Case”, organized by MSF (Doctors Without Borders).
Boycott is a good option, especially if we can make it globally, that’s what i call a strong cooperation. Petitions, boycotts, creative protests, they have to be as global as pharmaceutical companies markets.
I totally agree with you Kristin, “understanding what incentives need to be in place to convince them (the target) to change.”, but when we find out that this incentive is just profit, or when there is no interest in negotiations, more striking strategies must take place.
In Brazil we managed to issue a compulsory license for Efavirenz. In 2007, 75,000 patients, who represented 38% of patients undergoing treatment for HIV, utilized this medication. Each dose was marketed for about US$ 1.59/dose, or an annual cost of US$580/patient. Since November 2006, Brazilian Government attempted to negotiate a price reduction with Merck, emphasizing that the same company was selling the drug at cheaper prices in countries at the same development level, but with less people in need of treatment as Brazil. Besides that, Indian generic versions were available for US$0.45/ dose or an annual cost of US$164.25/patient. Merck, however, did not present an acceptable proposal, ignoring the size of the national demand. So, in may 2007 a compulsory license was issued for the initial import of generic versions produced in Índia.
This kind of attitude is not well seen and as consequence the country is included in lists like the special 301 report cited above. Government must decide tough between defending public health (witch means reduce costs to make its HIV universal treatment policy sustainable) and investing on its commercial relations. If companies lobby is strong because of their Power, civil society voice should be as loud as possible when needed, reinforcing that basical rights are at stake when this kind of negotiation is taking place.
Of course diplomatic solutions are the most welcome, that’s why It would be nice hear more about tactics using a persuasive approach, like this UEAM case.
Great thoughts. It's really helpful to hear more about your activities.
I suppose that I see persuasion as an early step on the activist/escalation spectrum. Like GTPI, we're an organization that uses evidence-based arguments in trying to convince people of our case. And that has definitely worked in making positive reasoned change such as the global access policy for intellectual property adopted by University of British Columbia working with UAEM students. But I suppose that "reasoned argument" working really depends on the attitude and good faith of who can decide to make the change you're after.
I think we unfortunately are not working with actors who work in this way in many cases.
I firmly believe that the only incentive that really matters in this space is money. I think any approach that is going to be effective in achieving our goals in conflicts with pharma companies needs to directly on indirectly threaten their income stream. In this context I believe that boycotting and bad PR can be very effective tools. Bad PR, or even the threat of bad PR, has been a strategy that UAEM has found effective in achieving our goals in the past. I think that a PR campaign that transitions to a boycott campaign has great potential to be effective. I agree that boycott campaigns would be most effective if they were expanded globally, particularly into markets like the US where pharma makes a large percentage of their total profits. I am not at all an expert in the history of pharma boycott campaigns, but I believe that a successful boycott in the US would not be impossible to put into effect, but it would need to have a simple message, involve both patients and doctors, and be very straightforward to comply with.
1) I think often it is tricky with campaigns involving complex legal/IP issues to simplify the issue to one sentence that people can get excited about, and I think it would be critically important to spend some time distilling the issue into the single sentence that anyone can understand and relate to.
2) I think that we could take a page out of the pharma book and usurp some of the highly successful marketing strategies that pharmaceutical companies employ in the US:
a. Marketing to both patients and doctors. Try to convince patients to ask their doctors not to use a specific drug or to switch them from a specific drug. Try to convince doctors to avoid prescribing a drug.
b. Pharma has a huge core of pharm reps who go in to doctors offices and give the doctors a brief spiel about their drug, and then hand out pens, paper pads, mugs etc with the drug name on it to leave lasting daily reminders in the office. What if we had a bunch of trained ‘boycott reps’ go into doctors offices, give a brief explanation of the issue, and then leave mugs and pens and paper pads etc that say something to the effect of ‘Don’t prescribe x drug!’.
3) Keep it simple. I don’t think that we should try to get people to remember a long list of drugs produced by a particular company. Rather, I think we should choose maybe even just a single drug which:
a. is a blockbuster or big profit generator for the company, and
b. has a number of essentially equivalent drugs in common use that are of similar price. The latter point could also be part of the ‘boycott reps’ pitch, explaining which alternative drugs could be used. An alternative approach if we wanted to target multiple meds would be to do one med per office. Eg: at cardiology offices target a commonly used cardiology drug, at primary care clinics target a diabetes drug, at neurology offices target a commonly used neurology drug, etc.
I'm not sure to what extent these strategies already exist or have been put into practice, but they could at least be interesting to explore...
Sara, thank you for these great ideas! I hope people will take you up on these ideas and suggestions.
I just wanted to share this campaign that I found on the DNDi.org site (Drugs for Neglected Diseases Initiative). I thought the message (the image to the right) is very clever and I wanted to share it with you all! This campaign was meant to educate people on the need for more government leadership in ensuring a sustainable commitment towards boosting essential health innovation. You can read more about this 2005 DNDi campaign here.
There is no information on how effective the campaign was, but it's at least an example of what is out there. You also have to love UAEM's slogan:
"celebrate the new campus drug culture: making medicines for people, not for profit"
Do you know of other clever campaigns?
Thank you for sharing this story, Felipe! It's quite a victory that GTPI was able to issue the compulsory license for Efavirenz! Congratulations! Can you tell us how you were able to do this?
The Treatment Action Campaign was able to push for a similar (or perhaps the same) kind of allowance of generics and they did this by illegally bringing the generic medicines into South Africa. Only then was this issue brought before the courts and the government finally used its power to issue the license (see my post for more details). How was GTPI able to put pressure on the government of Brazil to issue this compulsory license?
Kristin,
More information about the compulsory license in Brazil can be found at http://patentes.org.br/media/file/Publica%C3%A7%C3%B5es/Intelectual%20Pr...
About the TAC of South Africa I believe that their argument was that of an anticompetitive behaviour by the pharmaceutical companies.
Kind regards,
Francisco
World Trade Organization rules allow countries to issues compulsory licenses, which in effect allows them to legitimately use patents for generic production, in order to produce affordable medicines. There have been a number of important examples in which this allowed countries to make medicines affordable to their populations. In some countries, there is no ability to actually manufacture medicines, so also under WTO rules, a country can use their rights to have a medicine manufactured in another country and then exported to them. In order to use this flexibility, Canada passed the Canadian Access to Medicines Regime which allows Canadian generics companies to export medicines to poor countries. For a variety of bureaucratic reasons (which you can read about here), the system is very flawed and hence it has only been used once. There is a campaign under way that presents an opportunity to fix the system. The bill has moved quite far through Parliament with some flaws added in along the way. But we're hopeful that it can be fixed if a wide variety of groups continue to put pressure. You can read more about the campaign here.
Ethan,
Thank you for sharing this Canadian campaign to push for the ability of Canadian manufacturers of generic drugs to be able to export these life saving medications to poor countries. It seems that the World Health Organization (WHO) was able to influence the World Trade Organization enough to provide a mechanism to combat the stringent application of TRIPS to bring access to medicines to poor countries.
In that same vein, I was struck by one of the Canadian campaign arguments focusing on the deprivation of these drugs resulting in the death of many children.
Has any organization sought to connect this aspect of health care to any UN mechansims - such as the International Covenant on Civil and Political Rights and its Optional Protocol to the International Covenant on Civil and Political Rights? I was thinking about whether such campaigns could be framed highlighting Article 6?
The very first aspect of Article 6 is - "Every human being has the inherent right to life. This right shall be protected by law. No one shall be arbitrarily deprived of his life."
Do you or others think an argument could be made that the deprivation of lifesaving drugs is in fact arbitrarily depriving those in poor countries of their lives because the cost of patented medicines is out of reach?
Any thoughts or reactions?
The idea of using Art. 6 of the ICCPR is an interesting one - I don't know the historical success groups have had proving that the article requires positive action on the part of states to protect the lives of their citizens rather than simply refraining from killing them. Is anyone more familiar with this?
Although this doesn't diminish the exclusivity granted by stringent patent and trade secret agreements, it seems that within the current regulations, several countries' means of getting around barriers to access to essential medicines have been to manufacture these medicines by themselves. Of course, this has resulted in the EU's pursuit of the free trade agreement with India that would restrict Indian drug producers from making affordable generic medicines. However, over the past five to ten years, several African countries such as Kenya, Nigeria, Uganda, South Africa have begun producing important HIV/AIDS medication, which somewhat reduces costs by at the very least lowering transportation expenses.
On the patent front itself, one of MSF's lawyers currently working against the EU-India free trade agreement cites that in the past, one of the ways in which they've managed to successfully campaign for changes in patent laws was
"to demystify how patent monopolies work. I think often people don't understand why a drug is expensive. They just assume that the drug costs a lot to manufacture. Whereas in fact it is the monopoly protection afforded to companies by patents that allows them to get away with charging very high prices. Getting this across to people and politicians to mobilise them takes a huge effort. We were successful finally because we worked in partnership and coalition with the very strong and influential activist groups here."
I think it's in the interest of pharma and certain governments that the processes of drug manufacturing and patenting remain opaque to those not involved. Even basic information campaigns could help to make a difference in how people respond to barriers created by intellectual property.
Also, discussed elsewhere in the dialogue but not on this thread, the Medicines Patent Pool appears to be a step in the right direction that could be powerful if it expands. Its goal - for anyone newly learning about it - is to negotiate "with patent holders to share their intellectual property with the Pool, and then licensing it to other producers to facilitate the production of affordable generic medicines well-adapted for use in resource-poor settings." Right now their focus is geared towards patents surrounding HIV/AIDS medication, which, while not overcoming all barriers to access to medication by any means, offers the opportunity to bring together the various technologies that are necessary for the production of generic versions of these drugs. They're also interested in facilitating new medicine formulations, including versions for children and versions in which several drugs are combined into a single pill.My understanding is that the US National Institutes of Health (NIH) was the first (and only?) to share its patents with the Patent Pool back in September last year (2010).
But to strengthen the project other patent holders also need to share their patents so as to clear the legal path for production of affordable, generic HIV medicines; something, for example, Tibotec (of Johnson & Johnson) and owner of important patents for HIV/AIDS medication has declined to do. As it stands, multiple patents are involved in creating the "cocktail" of HIV/AIDS medication, so the patents licensed by the NIH are not sufficient to produce or sell any single drug. Would boycotts be an effect of means of pressuring companies like Tibotec - or perhaps Johnson & Johnson might make a more accesible focus? Does anyone know if other countries have departments comparable to the NIH that could be pressured to participate?
If you want to read more on the Medicines Patent Pool they have a pretty comprehensive website: http://www.medicinespatentpool.org/
Thank you, Kaija, for adding the patent pool tactic to this discussion! I know that there are many organizations and activists dedicated to implementing this approach so it is something that we should be familiar with. The idea of 'pools' have been mentioned already in a few other places in this dialogue:
I am curious to know what you all think of the use of "prizes" to stimulate innovation around new medicines, vaccines, technology, etc. This is a market-based approach in which research and development organizations (R&Ds) compete for rewards for specific R&D output. Here is a more detailed description of this approach, taken from the KEI website:
In a simple formulation, governments would place large sums into a fund that would be allocated every year to firms that bring new products to market. This could work with or without patents. If products were protected by patents or other intellectual property claims, the government could grant compulsory licenses (a procedure allowed by trade agreements to override monopoly rights on a patent, in return for compensation to rights owners) and permit rapid introduction of generic competition. The reward system could be a lump-sum payment, eliminating any incentive to continue to market the product, or a long-term payout structure, which would depend upon evidence of both usage and efficacy.
What do you think of this approach? What has been your experience? Do you have any examples of this working successfully? Any examples of this not working at all?
I haven't commented much--sorry I got busy planning my own symposium on A2K, which starts at Concurring Opinions tomorrow. I thought I might just point people to the book we will be discussing, because it has some real heavy hitter activists in it (Amy Kaczynski, Gaelle Krikorian, Lawrence Liang, and Chan Park). I had a few thoughts on the degree to which A2K movements around the world can unite.
The edited collection Access to Knowledge in the Age of Intellectual Property is an extraordinary achievement. Many essays offer models of engaged scholarship. The book as a whole reminded me of what Ian Shapiro described as problem-driven (rather than method-driven) scholarship. Shapiro argues for the superiority of "problem-driven over method-driven approaches to the study of politics,” making “the case for starting with a problem in the world, next coming to grips with previous attempts that have been made to study it, and then defining the research task by reference to the value added." He argues that "method-driven research leads to self-serving construction of problems, misuse of data in various ways, and related pathologies summed up in the old adage that if the only tool you have is a hammer everything around you starts to look like a nail.”
Problem-Driven Research
By contrast, problem-driven work tries to reason about a puzzle, injustice, or inequality, by drawing on the full range of methodological resources developed by social scientists. Krikorian and Kapczynski welcome the perspectives of health workers, activists, social critics, and academics. All the contributors think critically about access to knowledge, unshackled from disciplinary blinders that can lead to what C. Wright Mills calls "abstracted empiricism." The A2K paradigm addresses a very large issue: access to knowledge writ large. For A2K activists and academics, there are common problems besetting individuals in both the developed and developing world, who all find themselves hemmed in by patent, trademark, and copyright laws. As the introduction puts it,
On the one hand, I find this type of parallel very appealing. We are in an era of globalization which tends to fragment the interests of labor across national, ethnic, and class lines. A2K envisions the unity of consumers. Given the shift from producerist to consumerist economic models, advocates need to develop a theory and practice of social justice from the user's perspective. The old paradigm was a just wage; a new model of distributive ethics might instead focus on providing certain social minima, particularly those which can be copied at zero marginal cost.
Divergent Problems in the Developing and the Developed Worlds
Few should quarrel with efforts to provide knowledge-based goods for free (or very cheaply) to the world's bottom two income quintiles. At present, that 40% of the world's population can barely access more than one percent of global product. Their purchasing power is often exhausted by the provision of bare necessities. You can't squeeze blood from a stone, and while there is some evidence that charging a nominal amount for mosquito nets makes people value them more, you can't have too many such initiatives in the developing world without ruining their ostensible beneficiaries. When it comes to educational supplies and medicines, there should be a norm of charging (if at all) based on "ability to pay." My only reservation about the terms of this tactical alliance arises out of my study of inequality and the digital labor movement described by Trebor Scholz. Many Silicon Valley gurus have declared that we live in an age of "free." Artists are supposed to give away images of their paintings; writers are supposed to make everything they do available for free online; journalists are to be replaced by hordes of citizen reporters who describe events, as they see them, in their twitter feed. In an unfortunate metaphor deployed by one law professor, content is mere "paint" to be organized into "pictures" by the truly creative force of computer-driven aggregators and taste makers. I am afraid that if the normalization of "free" is a goal of the access to knowledge movement, it may contribute to unfortunate background economic trends that could liquidate the creative class and a large number of knowledge workers. I am all for uncontrolled access to software, journalism, and any other product with zero marginal cost of copying, once the underlying social problem of providing food, shelter, transport, and healthcare has been solved for all those working in such fields. Until then, it makes a great deal more sense to me to tax the likes of John Paulson to help pay for access to drugs, news, and education in the developed world. In other words, if anyone has to give something up in order to promote access to knowledge in the developed world, the first to sacrifice should not be those scrabbling for a living as newspaper writers or designers. Among the top 15,000 taxpayers in the US in 2005, the average tax return reported $26 million of income, and the “Fortunate 400”--the 400 households with the highest earnings in the U.S.--made on average $213.9 million apiece. (The cutoff for entry into this group was a $100 million income.). Taxing that group more fairly---and indeed anyone making over $250,000 a year---could create the type of economic security in the US that really lets creativity flourish. Just ask JK Rowling!
To conclude: I'm completely on board with the A2K agenda for the developing world. I also think the movement has a very important role to play in encouraging sequential innovation and the freedom of individuals to tinker in various cultural and technical contexts. I just worry about creative individuals and knowledge workers generally eventually finding that social norms of "sharing" and "compassion" leave them in the same disprivileged position that women, as constant providers of "unpaid labor" in the home, have suffered for centuries.