Intended for healthcare professionals

Analysis And Comment

Fair trade for surgical instruments

BMJ 2006; 333 doi: (Published 03 August 2006) Cite this as: BMJ 2006;333:297
  1. Mahmood F Bhutta (, specialist registrar otolaryngology1
  1. 1 Department of ENT, Guy's and St Thomas' Hospital, London SE1 7EH Mahmood F Bhutta
  1. Correspondence to: M F Bhutta
  • Accepted 31 May 2006

We may all be trying to buy fair trade coffee and bananas, but do we know where our surgical instruments are made, and under what conditions?

The global trade in medical commodities amounts to billions of pounds each year (, with much trade between the developed and the developing world. The pricing and availability of pharmaceuticals, medical equipment, and biotechnologies, and the potential conflicts of interest and ethical issues, have all been questioned. Perhaps the most publicised case has been that of the provision of affordable medicines to combat the spread of HIV in the developing world,1 where international pressure resulted in drug companies cutting prices. Many other medical commodities (such as MRI scanners and endoscopic equipment) are too expensive for the developing world because costs of research and development are high.

Although many have argued the case for subsidising medical and pharmaceutical supplies to aid the developing world,24 the developed world may in some instances be compounding the problem through its own sourcing of medical supplies. Unlike the campaign for the fair trade of goods such as bananas, coffee, and sugar, there has been no such campaign for medical commodities. No systematic investigation has been undertaken into the sourcing of healthcare goods used in the developed world. When these have come from manufacturers in the developing world then, as is the case with other goods, the trade may be open to the exploitation of power by transnational companies, driving down prices and labour standards.

The scale of any such abuse is difficult to ascertain, because we usually do not know or ask where our healthcare products are manufactured or sourced. The trade in surgical instruments is open to unethical sourcing because many such instruments are manufactured in the developing world. This is rarely brought to …

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