For the present system to work, poor people must be excluded from the innovation, because if they could get access at an affordable price, then affluent people would find ways to buy it cheaply as well - and then the innovator would be poorly rewarded and introductions of new medicines would decline.

Feudalism is an economic system where a few people own all the land and the others have no option but to be serfs on such a feudal estate. We now condemn feudalism. We condemn not merely the feudal lords but we condemn the whole structure of rules that sustained feudalism. I am asking people to think similarly about the world economy.

Poverty persists, essentially, because the people at the bottom - the bottom quarter and also the bottom half - see the gains from the rising global average income wiped out by severe declines in their relative share.

Critical journalism has gone out of fashion, or rather, it has been bought out. And so, we have much less of it than we did during the Vietnam era, where there was very critical reporting on the Vietnam War and a lot of disagreement among the media. Now you find that the media are much more homogenous, converging because they all must cater to the same community of advertisers. It's sad to see.

You can think of the Health Impact Fund as a mechanism that would keep the benefits and burdens of pharmaceutical innovation for the affluent roughly as they are while massively reducing the burdens presently imposed upon the poor. This sounds like magic. But it really works because the current system is not Pareto efficient. It's a system that generates hundreds of billions of dollars in litigation costs and deadweight losses that HIF-registered medicines would sidestep. By avoiding these losses, the HIF reform can bring improvements all around - including for pharmaceutical innovators.

Often vastly more important, international agreements are not routinely published in draft form or publicly debated, and civil society organizations and ordinary citizens often learn of important global institutional design decisions only after they have already been finalized and adopted. The only reliable way to be kept informed and to exert timely influence is by lobbying and paying the politicians and their negotiators.

We live in a world where economic positions - income and wealth - are very unevenly distributed, and this leads to the widespread persistence of poverty.