Politics & Power Quote by Paul Farmer

Farmer’s flat insistence on “the same therapies” is doing two jobs at once: it’s a clinical claim, and it’s a moral trap for anyone tempted to rationalize unequal care. By framing the issue as physiology, he yanks the conversation away from the soft, patronizing language of “cultural difference” that so often gets used to excuse second-tier medicine for poor patients. The line lands because it treats biology as the least negotiable terrain. If bodies respond similarly, then variation in outcomes has to be explained elsewhere: not in race, not in “national temperament,” but in access, infrastructure, and political will.

The subtext is vintage Farmer: medicine is political, even when it pretends to be neutral. “No reason to believe” reads like calm scientific restraint, but it’s also a rebuke to a whole history of medical racism and to public-health triage dressed up as pragmatism. Farmer knew how quickly resource scarcity becomes an alibi. If you can claim Haitians or the rural poor are “different,” you can justify cheaper regimens, delayed rollout, or the kind of care you’d never accept at Mass General.

Context matters: he was arguing against the 1990s-era consensus that complex HIV treatment was unrealistic in low-income settings. His statement is less about denying culture than refusing to let it be weaponized. Culture shapes stigma, adherence, and trust; it shouldn’t determine whether someone gets the gold-standard drugs. The point is blunt: inequality isn’t a clinical inevitability. It’s a policy choice someone has to own.