Drugs in Mexico: Ethical Variances and Legal Responsibilities with Respect to Pharmaceutical Companies
No wonder they went to Cabo for drugstore antibiotics.
We as a society love to assert blame on a person’s state of health and wellbeing as solely the result of individual decisions. Asking why more patients are not accountable to their own primary care and healthcare needs is a very loaded question, and without assessing the factors contributing to health and wellness needs and medication adherence, the heart of the matter will never be fully appreciated. Social determinants of health (SDOH), such as an individual’s neighborhood and the built environment, economic stability, pharmaceutical industry barriers to access through cost containment, and the legal and ethical variances across borders all entangle below the surface and create this stark reality for many individuals in society: it can be extremely difficult to reliably get medication on a consistent basis. I want to be very clear: no individual’s state of health is wholly the result of their decisions. But parsing the existential threats to an individual’s access to adequate healthcare and medications and assigning responsibility for alleviating these pressures is a hard sell in capitalism. For this reason, asking, “How did we get here?” must be reviewed laterally, examining how things are different under other economic and political systems.
Ethical Variances Across Borders
SDOH is an expression that encompasses many different constraints that intersect and create setbacks for individuals accessing healthcare and prescription medication. It is a matter of privilege, but it is also a matter of ethics. SDOH are embedded in the American Nurses Association Code of Ethics and impact generational lifespan and widespread health disparities (Delehant et al., 2024). Patients don’t know what they don’t know, and health literacy thus becomes a tool of the privilege. Prescribing a patient medication without fully assessing their readiness to learn about that medication is at best inefficient (patients who don’t understand why they’re taking a medication are less likely to feel empowered to take it) and at worst unethical (this is arguably a violation of the oath to “do no harm”). Kvarnstrom et al. (2021) credit this to the information-motivation-behavioral skills (IMB) model, which identifies information about the need for medication adherence behavior, motivation to make changes in favor of medication adherence, and possessing the skills necessary for achieving medication adherence as the three “legs” of a triangulated phenomenon. Neglecting to find out if a patient can logistically get to a pharmacy to get their medication before sending them to that pharmacy is arguably a form of neglect. In doing research in Franklin, Virginia, a rural city in Southeastern Virginia, I have had the privilege of getting to know local residents who take advantage of the free health clinic the university provides to attendees at the Foodbank. When asked if they have taken their medication, more than a few weekly respond that they haven’t. When asked why they haven’t taken their mediation, again, more than a few respond with “my doctor just left”. What has happened, is that fledgling providers establish practice in this community for two to three years to fulfill their graduate level educational financial aid indentured servitude—and then leave to pursue practice in areas where the paychecks are larger. This leads to patients being shuffled between clinics and being forced to go without medication until they are able to get in with the next fledgling provider willing to take them in and refill their medication. Is it legal? Well, it is not illegal, but the ethics of this phenomenon are questionable.
In Mexico, a country that strives to fulfill the Sustainable Development Goals proposed by the United Nations through shifts in public policy, has focused efforts on removing barriers to access for its most vulnerable members of society. More specifically, Mexico implemented Seguro Popular in 2004, a public insurance program that is designed for the roughly 60 million without social security to ensure access to medications and other healthcare amenities (Gomez-Dantes et al., 2022). From 2000-2018, the Mexican government actively and progressively implemented public policy measures that improved the purchase of pharmaceutical drugs through the national health care system, strategically taking advantage of purchasing generic drugs and single-source drugs for disbursement to the public through general hospitals and outpatient clinics; this was in addition to the creation of the Coordinating Commission for Negotiating the Price of Medicines and Other Inputs, which negotiated lower drug prices and increased access to life-saving medication for disadvantaged Mexicans (Gomez-Dantes et al., 2022). As compared with 340B and medication in the United States, we see where a similar initiative—having healthcare entities purchase medications and distribute them at discounted rates through community clinics and hospitals—had promise but fell short when it came to granting access to free and charitable clinics and charitable pharmacies (What you need to know about 340B and medication access). These institutions, which provide life-affirming health and wellness care to disadvantaged patients, are considered not eligible entities for the program, and this is a blatant ethical violation as it denies available medication access to those who need it most but are least able to afford it. Furthermore, legislation Congress designed to institute prescription drug pricing reforms has failed year after year, as the influence of lobbyists on behalf of Big Pharma continue lobbying for their ability to control medication pricing. Often, the need to sustain research and development is cited as the driving reason behind exorbitant drug prices, but whether or not this is justified remains questionable (Angelis et al., 2023).
In sum, the regulation of medication prices in Mexico due to public policy reform across multiple political administrations contributed to a reduction in prescription prices and greater access to prescription medications for disadvantaged populations in society. In contrast, in the United States, Congress continues to let Big Pharma control drug pricing with minimal regulation. This is a significant factor contributing to the variances in prices for drugs like insulin or antibiotics in Mexico as compared with the United States. Though Mexico is technically a capitalist nation, as I the United States, it is still considered a mixed economy in the private sector has a domineering influence on the market, but the government still has a hybrid, significant influence on the economy. On the other hand, the United States is in late-stage capitalism, wherein the multinational corporations, widespread consumerism, and extreme wealth inequality are the driving forces behind markets. In contrast to Mexico, the government, through lobbying and private interests, bends the knee to the domineering private sector forces with deep tentacles into the market. This gives the Mexican government more control over drug pricing, and the private sector more influence over drug pricing in the United States.
Unfortunately, though, the problem is not as simple as having Congress simply enforce price reduction on the pharmaceutical companies, and this may not be an ideal end game. South Korea is an n=1, anecdotal example of what happens when a government does precisely this. Four policies that were directed at pharmaceutical cost containment and involved direct price cuts or modifications to physician prescribing resulted in immediate reductions in prescription prices for the public. However, the effects of these changes plateaued over time; thus, the positive effects experienced were ephemeral. Thus, a middle ground or happy medium must be achieved, what will continue to allow for the benefits of lower drug costs to be realized over time, and remain that way through the pressures of inflation, recession, and other such market variable conditions.
Legal Responsibilities of Pharmaceutical Companies
Anyone who has turned on a television streaming service, used YouTube, or opened a magazine in the United States within the past decade has seen pharmaceutical commercials, often ad nauseam. Pharmaceutical companies lobbied the government for the legal ability to engage in direct-to-consumer advertising, with arguments that it would give patients more advocacy power by “asking their doctor” if a specific drug is appropriate for their condition. Since 1997 when first instituted, legal battles between the Food and Drug Administration and Big Pharma have swung the pendulum back and forth concerning the pharmaceutical industry’s right to influence the public. Laws and policies concerning the role pharmaceutical companies can play in influencing public opinion and spending money have evolved through the decades, but the underlying constant is that pharmaceutical advertising places the financial interests of drug companies over educating patients about matters related to safe medication usage (Bates & Schrader, 2023). For example, pharmaceutical companies are not required to educate the public about polypharmacy and the risk for poorer health outcomes when five or more drugs are consumed simultaneously. The best interests of the pharmaceutical companies are profits over people, and this conflicts of the best interests of the patient: securing reliable, safe access to affordable care based on their health history and the recommendations of their provider. Across the European Union, however, direct-to-consumer advertising of pharmaceuticals is largely prohibited. Many physicians argue this interferes with providing appropriate care to patients, as advertised drugs may not be in the best interests of a patient who insists on getting prescribed a drug they see on television.
References
Angelis, A., Polyakov, R., Wouters, O., & Torreele, E. (2023). High drug prices are not justified by industry’s spending on research and development. BMJ, 308. https://doi.org/10.1136/bmj-2022-07171Links to an external site.
Bates, S., & Schrader, V. (2023). “Talk to your doctor:” A rhetorical analysis of Burkean identification in direct-to-consumer pharmaceutical advertisements. CTMJ, 46(1) 70-99. https://cornerstone.lib.mnsu.edu/cgi/viewcontent.cgi?article=1160&context=ctamjLinks to an external site.
Delehant, S., Hatton, J., Sudhalkar, H., & Scruth, E. (2024). Social determinants of health: An ethical approach. Clinical nurse specialist, 38(2) 65-68. https://journals.lww.com/cns-journal/fulltext/2024/03000/social_determinants_of_health__an_ethical_approach.3.aspx?context=latestarticles&casa_token=R-TnJRiPiO0AAAAA%3A76lQ4G5i8uhLUK9e73zH1htyGCn2YrnCIinqqj9C4kVTdnrwp5ohg8fcStNSgX9hFzdwBXsbb4Kf2Pb7DZtybCULinks to an external site.
Gómez-Dantés, O., Dreser, A., Wirtz, V. J., & Reich, M. R. (2022). Challenges of Guaranteeing Access to Medicines in Mexico: Lessons from Recent Changes in Pharmaceuticals Procurement. Health Systems & Reform, 8(1). https://doi.org/10.1080/23288604.2022.2084221Links to an external site.
Kvarnstrom, K., Westerholm, A., Airaksinen, M., & Liira, H. (2021). Factors contributing to medication adherence in patients with a chronic condition: A scoping review of qualitative research. MDPI, 13(7) 1100. https://doi.org/10.3390/pharmaceutics13071100Links to an external site.
What you need to know about 340B and medication access. The National Association of Charitable and Free Clinics. (2025, October 17). https://nafcclinics.org/what-you-need-to-know-about-340b-and-medication-access
TL;DR: The Quick Recap
Health is Not Just a "Choice": Stop blaming the patient. Medication adherence is a "triangulated" feat of information, motivation, and—most importantly—logistical skill. If the neighborhood lacks a pharmacy or the doctor just "left," the patient isn't failing; the system is.
The "Fledgling Provider" Loop: In places like Franklin, VA, patients get stuck in a cycle of "indentured servitude" providers who leave for bigger paychecks, leaving high-risk patients without refills or continuity of care. It’s legal, but is it ethical? (Hint: No).
Mexico’s Playbook: Through Seguro Popular and aggressive price negotiations, Mexico has prioritized generic drugs and public access. They’ve managed to treat healthcare as a public policy goal, whereas the US 340B program often leaves free clinics in the dust.
The Late-Stage Capitalism Problem: The US government "bends the knee" to Big Pharma lobbyists. We prioritize "Research & Development" (and massive marketing budgets) over affordable insulin and antibiotics.
The Direct-to-Consumer (DTC) Trap: While the EU bans drug commercials, the US floods our screens with "Ask your doctor" ads. This centers financial interests over actual patient education, often ignoring the risks of polypharmacy.
The Goal: We need a "Happy Medium." Pure price cuts can be ephemeral (see: South Korea), but letting corporations control the price of survival is an ethical "do no harm" violation.