Jim began by responding to Anita’s question about his journey from public-health ethics to research ethics to equitability. 

At the core, Jim’s journey has been from narrowness to breadth without stepping away from depth.  His appreciation for the consequences of gaps in health systems in LMICs has been amplified over time.   He’s now thinking about how companies do contribute to the public interest, and how this rests on questions of distribution and health systems in places where drugs are needed most.

Jim also brought up the question of when and how companies become comfortable with doing drug development for diseases of the poor.   He is thinking extensively with his team about the incentives that companies have to engage on these issues.

This led Anita and Jim to think about what constitutes the public interest in the first place.  Are we seeking to export models of profitability when private pharma companies go into LMICs?  

Jim agrees that there are many challenges, and yet, at the same time, what characterizes a public problem are a series of characteristics that can shape our solutions.  These include that they affect vulnerable people; they involve social arrangements that privilege and advantaged minority; and solutions usually require painful losses for powerful people.    How do we get there?   It’s not easy.   We need to think carefully about what we want as a community.

Lots of Jim’s work now is on layers of community and their implications.  There are a number of important characteristics of interests that have emerged through his work including that we need deep understanding of stakeholder interests, and then stakeholder engagement in consideration of the implications.

Anita and Jim talked about Jim’s work with Pfizer, a company that both admire. 

After 10 years on the Bioethics Council at Pfizer, Jim came to appreciate how smart and committed its people are to equity in access to healthcare.  Pfizer is funding a project that Jim is now doing at Emory on how to make the system more equitable.   Some ideas that are emerging:

·       There is no shared understanding of what constitutes equity.   We all want it.  But what is it?

·       Everyone is working within constraints. 

The goal now is to try to think creatively about the accountability of companies to the public investment in science that has made drug development possible.  

What makes Jim optimistic?

There’s a lot of reason for pessimism, but in the end, it is our students that make Jim optimistic.  There are tons of struggles, but young people in our classrooms have clarity about their convictions.  They are interested in justice.