February 23, 2012

Philosophy Student to Project Manager

Working for the Health Impact Fund

by Kate Marcal

Katie Lewis, a 2011 graduate of Washington University, is now working with philosopher Thomas Pogge at Yale University. A native of Denver, CO, Lewis earned her degree in philosophy from the College of Arts and Sciences. I spoke to Katie about her work with Pogge on the Health Impact Fund and how her approach to philosophy has changed since leaving St. Louis.

KM: What kind of work are you doing with Thomas Pogge?

KL: I’m working in three different but related capacities. I’m acting as Project Manager for two nonprofit organizations that he founded- Incentives for Global Health and Academics Stand Against Poverty- and am helping him with small research tasks. Incentives for Global Health is working on a proposal called the Health Impact Fund, which proposition I first encountered in a philosophy class with Kit Wellman at Wash U. The Health Impact Fund would provide a supplement to our current system of paying for pharmaceutical innovation under the TRIPS regime, which is clearly deeply problematic. The most obvious flaw of our current system is that it obstructs access of millions of people to medicines that could save their lives and that can be produced very cheaply. It does this by allowing the pharmaceutical companies really only one way of recovering the enormous amount of money they spend on research and development- selling their drugs at hugely marked-up prices while they are protected under patent, thereby blocking access of very poor people and the health systems of developing countries. The HIF provides for pharma companies a thoroughly optional alternative. If they choose to forego patenting a new drug and instead register it with the HIF, they agree to make the drug universally available at something close to cost of production- which is very cheap. The company is then rewarded from the Health Impact Fund based on the actual impact of the drug on global health.

I’m also working for Academics Stand Against Poverty (ASAP). The founding of ASAP was predicated on the realization that the incentives in academia are organized in such a way as to reward disagreement; people get published for showing how their ideas are different from those of other scholars, not for collaborating and agreeing with one another. A substantial barrier to large-scale poverty alleviation is the spreading of valuable resources (time, money, skill etc.) among too many different agents with the same good will and good ideas. Thus, ASAP creates a platform to mobilize, unify, and coordinate academics around the world behind a small number of well-researched and empirically sound reform ideas. By pooling our resources and enlisting the help and expertise of organizations outside of academia, we hope to achieve institutional reform that will work towards alleviating global poverty and keep governments around the world focused on the poverty problem.

KM: What is the current status of the Health Impact Fund?

KL: The Health Impact Fund has come a long way toward realization and has also a long way to go. In order to get widespread support for the fund, and particularly sufficient financial support from governments, we have to prove the practical feasibility and merit of the idea. So the main proximal goal is to conduct several pilots of the project. One of the main innovations of the Health Impact fund is to introduce a value-based reimbursement mechanism based on averages in health improvement into the system of medicine provision. One of the fundamental goals of the pilot program is to test our ability to measure the health impact of diverse drugs in diverse countries and then to see how this pay-for-performance scheme affects the behavior of the drug company involved in the pilot. We want to know if the scheme effectively incentivizes manufacturers, for example, to take extra measures to make sure that the drugs get to the patients who can actually benefit from them, are taken in the right dosages, etc. We are currently in the process of negotiating different pilot proposals with various drug companies, funders, and government officials.

KM: How will you measure the health impact of a specific drug?

KL: The measures of health impact used in each pilot vary depending on which drug is involved and which indications of health improvement are associated with the diseases those drugs target. We are working with several leading health organizations including NICE International, George Institute for International Health, and the Institute for Health Metrics and Evaluation to create accurate rubrics for measurement.

KM: How did you get involved in this project with Thomas Pogge?

KL: I met Professor Pogge during my senior year at Wash U. I was writing my senior thesis on his work and asked if he would meet with me to talk about these ideas while I was visiting my brother in New Haven. He was very supportive and very obviously interested in doing whatever he could to give young people opportunities to get involved in this kind of work. I had hoped, ever since encountering his ideas in Kit’s class that I could find a way to contribute to practical efforts at implementing them, and I was lucky enough to find the opportunity to do so.

KM: What appealed to you about this kind of work?

KL: I was very frustrated with myself by the end of my college career. I had the sort of quintessential privileged philosophy student breakdown brought on by the luxury of sitting in this beautiful university debating the character of our duties to save the lives of millions of people who we have the power to save. I wanted to find a way to get involved with the practical side of what I had been studying from a theoretical perspective and see how the two aspects related to each other.

KM: How successful do you think the project will be?

KL: I think that the Health Impact Fund will ultimately be successful; it just might take a bit more time than more orthodox projects. There is a lot of research being done right now around the merits of value-based reimbursement schemes, indicating that this is going to become an increasingly common paradigm. And the project has stirred a great deal of interest not only within academia, but among health officials in a variety of developing countries and leaders in the pharmaceutical industry, so I am very hopeful.