In Drugs for Africa: A Modest Proposal, David Friedman presents his suggestion:
Let charitable donors in rich countries buy out the patent on the second best AIDS drug or combination of drugs and public domain it — let anyone who wants make it. Buying the second best drug should not be that expensive, since it probably is not making much money any more. And even if the same company owns the first best drug, it should not lose too many sales, since most customers who can afford the best drug will keep taking it.This proposal has one large advantage over the usual alternative of forcing drug companies to make their drugs available at a low price in poor countries, with the threat that if they do not the countries in question will simply refuse to enforce their patents. That proposal makes the development of new drugs less profitable and so buys a short run gain in availability at the long run cost of slowing the development of new drugs. It could be a very large long run cost if the practice spreads from very poor countries up to less poor countries.
My proposal, on the other hand, makes the development of drugs more profitable.
Actually, that’s his palatable suggestion. He also makes a less palatable “modest proposal”:
FDA rules on testing should be designed to encourage drug companies to make not yet approved drugs available abroad in order to use the information so generated to meet the requirements for approval in the U.S. That would bring down the cost of finding out whether new drugs are safe and getting them approved. At the same time it would provide low cost — albeit somewhat risky — drugs for people in poor countries.
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Opponents will argue that it is unjust for rich people to get the best drugs and poor people the second best — even if the realistic alternative is poor people not getting any drugs at all. They will make good demagogic use of the idea that it is wicked to use human beings as guinea pigs for potentially dangerous drugs — despite the fact that using humans as guinea pigs is the only way we have of finding out whether or not drugs are safe.