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Penn Integrates Knowledge professor Ezekiel Emanuel is a globally renowned bioethicist.

Credit: Alexandra Fleischman

Universities exist to create and disseminate knowledge. Penn’s mission spans all disciplines of knowledge, providing education and advancement of established professions in Pennsylvania and beyond. President Amy Gutmann created Penn Integrates Knowledge professorships during times of economic malaise and global uncertainty. Loss of trust in society’s institutions grows daily. Finite resources produce reappraisal of values and priorities within Penn that inform the law, government and society.

In an op-ed published in The New York Times in August, PIK professor Ezekiel Emanuel described the painful reality of generic injectable drug shortages in the United States and their negative effects upon cancer and other patients. These shortages define and compromise existing standards of care for Perelman School of Medicine and all employed and independent health professionals. This unresolved health threat is presently accelerating. Causation is multi-dimensional but pervasive in its effects on cost-effective health care. Frequent clinical changes in drug protocols promote process of care preventable errors and excess labor inefficiencies, diverting scarce resources from other priorities. Such resource diversion threatens to slow Penn’s historical commitment to discovery of new knowledge.

The Food and Drug Administration and pharmacy profession documented this emergency, and President Barack Obama issued an executive order requesting enhanced FDA activity. Sen. Bob Casey has proposed legislation to enact new FDA authority. However, Washington political gridlock is unlikely to address this health and safety threat upon Pennsylvanians in a timely manner while realizing the necessary national budget reduction goals advocated by Emanuel.

Emanuel could promote the public’s trust in the Medical School by publicly asserting the meaning of personal trust that people expect of their professionals who possess knowledge, skill and expertise acquired from long training. The law classifies their relationships with patients as “fiduciary trusts,” in which the trust of the patient is the minimal hallmark of accountability under law.

Outdated federal Medicaid discounting laws create marketplace disappearance of long-established effective drugs. Historical Medicaid discounts compromise professional integrity, causing the disappearance of established standard treatments requiring use of costly second line alternatives. Under the common law, which governs professional trust relationships and predates the U.S. Constitution, the parens patria judicial doctrine should protect professional integrity from unresolved federal, executive and legislative indecision. Federal law requires hospitals to give Medicaid the lowest purchasing price in the marketplace, thereby diminishing the quality of care for all Medicare and other insured and uninsured hospital patients.

The public’s trust in the Perelman School of Medicine would be strengthened by documenting and disclosing data in order to justify the public value of sufficient reimbursed financing to promote industrial production of underpriced effective drugs to maintain established standards of care for all.

Emanuel worked for Obama’s budget director as a recognized authority in bioethics and economics of health policy. For Penn to retain the public’s trust as educator of the professions requires production of quantitative negative medical outcomes data arising from drug shortages. Innovation in risk management data collection and judicial protection from conventional malpractice actions will be needed to promote the public welfare. Data would confirm professional integrity breaches caused by drug market production failure beyond healthcare providers’ control. Judicial intervention in tripartite state government would be essential to minimize drug-rationing protocols. Budget capped or retarded resource allocation policy should assure generic drug supplies in balance with new knowledge and drug innovation activities within the University. The drug market could adapt to such realities but awaits political ownership of necessary unarticulated public financing.

Comprehensive review of state laws controlling pharmacy benefit management plan competition for all ambulatory and hospital drugs is essential. Medicaid formularies should include the generic injectables presently purchased, when available, in group purchasing organization contracts. Knowledge integration should inform comprehensive drug pricing policy.

Penn has the knowledge to address the public’s health. Emanuel and Gutmann should now provide leadership to walk the talk of knowledge integration for the betterment of people.

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