Leadership ethics in shaping global drug access policies
- R.M. Boylan
- Jan 16
- 8 min read
Updated: Feb 19
Access to Medicines: A Moral Concern
In the current global landscape, access to medicines is a critical concern impacting millions. As healthcare expenses rise, countless individuals find it challenging to afford essential treatments.
Healthcare access was and continues to be an election priority across nations. Issues relating to persistent medication shortages remain a global issue since the pandemic. This includes both innovative and generic drug access of essential medicines. Policy makers are juggling with drug shortage problems not understanding what lies beneath the problem and how they can solve it. When we peel the onion to its core many of the issues relate to leadership, decision-making and ethics around choices on all sides. Ethical decision-making requires high-mindedness and logic. As Voltaire said "Common sense is not so common."
At play are many issues too complex to discuss in this article. Policies and politics in the next 4 years in the United States, Canada and the European Union will have particular impacts on access for orphan drugs, rare disease medicines, women's health and oncology medicine access. In fact, policy and politics have already affected these domains despite it not being visible to the untrained eye.
Studies indicate that almost 30% of Americans have foregone medication because of its cost. (1) With drug regulations differing significantly between regions, the role of leadership ethics in drug access policy becomes crucial. This article explores how ethical leadership influences healthcare decisions, impacts public health equity, and promotes significant changes in drug access.
Our cognitive biases, belief systems and values as leaders in decision-making define how medicines are reimbursed and whether they will be reimbursed for many. This includes both those making decisions on the pharmaceutical side, the payer and politicians who define the context in which healthcare operates. Leadership, cognitive bias and belief systems play a role in access to life saving & life altering medicine access worldwide. Leaders influence other leaders. Nations influence other nations.
Not having access to an essential medicine may or may not determine a person's access to life. Leaders and decision-makers on drug policy indirectly and directly impact whether others will live or die. Also the conditions within which that life will live in terms of quality of life.
Access to medicines is therefore a moral and ethical decision not to be taken lightly by a leader and those below the leader.
Exhibit 1.0
Rational Decision-making models in Leadership
When creating strategies for drug pricing and launching new drugs in global markets, it is crucial to use an advanced model to evaluate value and shape the strategy. This involves all necessary aspects to make informed decisions that remove access barriers and ensure the smooth execution of desired outcomes. While health economics has been a tool in decision analytics, it needs to be simplified for practical negotiations. Not all decision-makers have science degrees especially politicians. The value dossiers must be simplified for all levels of government decision-making.
Logic: The "Affordability" Value Argument is the Deal Breaker
The sustainability and future of healthcare hinges on quality, accessibility, and affordability. Many pharmaceutical companies have concentrated solely on cost-effectiveness in their market strategies, neglecting the affordability issue. The affordability issue is addressed through a budget impact model, however, the budget impact model is rarely integrated into a solid negotiation strategy where health equity dimensions and ethical considerations are addressed.
The models and strategies must be developed to address "affordability" for decision-makers through negotiations. and also deliver tangible outcomes, including ethical and rational decision-making models to appease the decision-makers.
Cognitive Biases Removed in Decision-making
If we do not understand our mind and its cognitive biases when we make decisions, how can we make effective decisions? The issue of affordability in a context of scarcity is no longer separate from the issue of morality and bioethics. For this reason, a bioethical model has been developed to evaluate the value of a given medicine and the risks associated with not funding it. This allows the decision-maker to consider all elements when making a decision to randomly cut an entire category of drugs needed for a given population.
Sadly, we cannot agree as a group of divergent views except on variables that can be measured. Emotion has little or no place in rational decision-making. Emotion must be replaced with concepts that qualify and quantify ethics and the spectrum of consequence in decision-making.
Systems & Types of Government may be Veils for Planning Strategy
When analyzing systems and forms of governments, the leadership style defines the framework within which the system operates. These systems and types of government are structures that may act as veils. Behind which decisions are made based on various norms. Social norms, leadership styles, belief systems are more relevant to a well defined strategy for access than what you see on the surface.
To effectively negotiate changes in drug policy, global drug prices, and access to medicine, it is crucial to understand the leadership style that governs the system and structure. The leadership styles behind the veil is the chess game. Understanding this will determine the context in which our strategies will be implemented. If this is overlooked, the time required to achieve the desired outcome will be extended significantly.
Highly masculinized systems with high masculine index as per Hofstede's model will attribute little value in general to drug access. More importantly healthcare access will be streamlined in specific demographic groups more than others. It is important to understand the impact of these systems when developing a policy strategy for access. If your cognitive biases get in the way because you are male and you refuse to accept the research you are doing your organization a disservice by sabotaging proper planning. The research has demonstrated this phenomenon historically. Please see Hofstede's model below Exhibit 1.5.
Exhibit 1.1
The Role of Leadership in Drug Access Policy
In the healthcare sector, leaders have a significant impact on policies relating to drug access and patient care. Ethical leadership fosters a culture of transparency and accountability, ensuring that decision-making processes are grounded in fairness, ethical decision-making and logic.
Leaders prioritizing ethical standards are more inclined to push for policies that enable equitable access to essential medications. For instance, hospitals that adopt ethical practices often see improved trust among stakeholders, including healthcare workers and patients. This trust can enhance collaboration and lead to better healthcare delivery outcomes.
Ethical Frameworks and Their Impact
To understand the effect of leadership ethics on drug access policy, let's take a closer look at two major ethical frameworks: deontological ethics and consequentialism. The model I use is more complex involving Christian Bioethics applied to access to medicines.
Deontological Ethics: Leaders adopting this approach cling to rules and obligations. For example, a CEO might implement a policy mandating that all patients must have access to lifesaving medications, irrespective of their financial status. This fosters a sense of entitlement to care, as all patients know their requirements will be met.
Consequentialism: This perspective evaluates the outcomes of decisions. A leader focusing on the overall health benefits might support pricing strategies that benefit the majority, even if some specific groups experience limited access. Striking the right balance between these two frameworks is crucial for creating inclusive policies.
Navigating these ethical frameworks and others allows leaders to formulate drug policies that benefit all populations, prioritizing the overall welfare of society while remaining attentive to marginalized communities.
When we understand the different types of violence that exist, we dive deeper into structural violence. Structural violence is likely the worst form of violence as it is invisible. It is a form of violence embedded in decision-making in our hierarchies which intentionally removes specific subjects their access to basic needs to stay alive or be healthy. Access and denial of life saving medicines fits in the category of structural violence. Understanding how structural violence operates insidiously in a given government system is paramount to formulating the best strategy for access to orphan medicines, rare disease drugs and oncology drugs.
The Interplay Between Leadership Ethics and Drug Pricing
Drug pricing remains a contentious topic, intimately tied to leadership ethics. Decisions made by healthcare executives regarding drug costs can either ease or complicate medication access. The drug price must be justified using a variety of instruments which is a complex process never forgetting that the affordability criteria argumentation will define market access optimization through sales uptake.
Ethical leaders recognize that exorbitant drug prices can jeopardize public health. They advocate for pricing models that promote fairness and accessibility. For example, initiatives such as tiered pricing can be implemented, where drug prices are adjusted based on the economic conditions of different regions or populations.
Moreover, transparent pricing approaches build trust. When healthcare leaders openly share pricing strategies with patients, they encourage informed participation in treatment decisions. This can alleviate the anxiety associated with sudden price hikes, leading to better patient cooperation and adherence to treatment.
However, this may not be realistic given drug prices in many instances need to safeguarded depending on the market.
Exhibit 1.3
Addressing Systemic Inequities in Healthcare
Leadership ethics are essential in tackling systemic health inequities. Ethical leaders actively seek to dismantle barriers that restrict access to medications for vulnerable populations. Leaders with sinister plans and cognitive biases may be focused on limiting or destroying access for vulnerable populations. This may be a form of disguised eugenics which must be carefully examined. Markets with these sort of leaders must be investigated before launching drugs or investing exorbitant funds in market development. A financial and policy analysis would reveal whether the leader and the government system is appropriate for launch or not.
They can push for policies that address socio-economic determinants of health, such as expanded insurance coverage or financial aid for underprivileged groups. For instance, the partnership between health organizations and community nonprofits can lead to campaigns that educate low-income individuals about available resources and assistance programs. Such initiatives demonstrate a commitment to ethical principles that support health equity.
Following the second world war, Hofstede's evaluated cultures simliar to Adolf Hitler with high masculinity index vs. more feminine indexed leadership styles and cultures. In more feminine indexed cultures access to medicines would likely be better than high masculine indexed cultures. However, this may only be relevent to women's health, child health and vulnerable populations. The research must be done.
Exhibit 1.5
Engaging Stakeholders in Ethical Drug Access Policy
Ethical leadership thrives on collaboration and active engagement with various groups, including patients, caregivers, pharmaceutical manufacturers, healthcare workers, and policymakers. This engagement ensures that drug access policies reflect the needs of the communities they serve.
Creating open forums for discussions can yield diverse insights that enrich policy development. For instance, hosting public town hall meetings allow stakeholders to express their concerns and provide input on drug access issues. Additionally, forming partnerships with advocacy groups provides another avenue for gathering feedback and amplifying community voices.
Navigating Challenges in Policy Implementation
While ethical leadership greatly influences drug access policies, the path to implementation can be challenging. Leaders face various political, financial, and logistical hurdles that can slow progress.
Pushback from pharmaceutical companies or regulatory agencies is common. Ethical leaders can mitigate resistance by employing persuasive strategies to champion drug access priorities within their organizations. For example, they could present data demonstrating the long-term benefits of equitable drug access, such as reduced emergency healthcare costs, improved labour market participation and other social drivers of productivity.
Successful implementation of drug access policies requires resilience. Leaders should remain adaptable, continuously seeking innovative solutions while holding onto their commitment to fairness and equity in drug access.
Final Word: Ethical Leadership in Drug Policy & Patient Access
Leadership ethics forms the foundation for effective drug access policies. By harmonizing moral principles with practical strategies, ethical leaders can facilitate real change in the healthcare landscape, ensuring that essential medications are available to all.
The challenge lies in cultivating leadership that values transparency, inclusivity, and equity. As discussions surrounding drug policies evolve, leaders must stay vigilant and ethical in their approach, advocating for every individual's right to the medications they require. Ethical leadership is crucial to fostering a more just and equitable healthcare system where everyone has the opportunity to thrive.
Exhibit 1.6
3). Boylan, R.M. (2006-2009). Conflicts and considerations comparing Abraham Maslow's hierarchy of needs to Jane Loevinger's model of ego development for assessing the level of development of a leader. M.A. Leadership Studies.
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