Sunday, October 19, 2014

Why is there no Ebola cure?

Ebola was first discovered all the way back in 1976 and has been part of the public imaginary since the publication of The Hot Zone by Richard Preston in 1994. There have been 26 outbreaks so far, with the largest until now costing 224 deaths (of 425 infections) in Uganda in 2000-1. We are obviously currently experiencing the deadliest outbreak in the history of disease ravaging Western Africa as usual, but spreading to Spain and the U.S., already counting 9,286 incidents and 4,597 fatalities. Yet in those nearly four decades, no drug has been approved to treat the horrifyingly deadly hemorrhagic disease. Why?

The answer is both obvious and rather disturbing – profit margins. Pharmaceutical companies deciding where to spend their research and development funding generally look at the potential for future revenue streams. And curing or treating diseases in the Global South (developing and underdeveloped countries in Africa, Southeast Asia and parts of South America) is just not as profitable as palliatives for Western diseases and conditions or, at the extreme, making up things like “General Anxiety Disorder” and “Restless Leg Syndrome” so they can sell even more treatment. In fact, the pharmaceutical industry made a rather disturbing discovery in the late 70s – it is substantially more profitable to treat the symptoms of a condition (palliative) than to actually cure diseases. And thus the explosion of anti-depressants, EDD drugs a decade later, ADHD treatment (essentially speed) and the like.  New diseases? Just not as profitable, including new more potent antibiotics to treat the growing strains of drug-resistant microbes. And while the government has partially or wholly funded many of the most important patents in the industry for the past 50 years, they appear to have little power to actually influence what the companies do or how much they ultimately charge for the drugs they do create that actually save lives.

Diseases that strike the poorer countries thus receive almost no attention at all. Beyond Ebola, malaria and tuberculosis (which kill a combined 2 million people a year) receive less attention than high cholesterol, Chagas, dengue and other “neglected tropical diseases (which affect a billion people and kill as many as 500k) have 10 marketed drugs of the over 15,000 that came to market between 75 and today. And the same is the case in the West, with more drugs targeted toward the middle and upper class, male over female treatment, and white over minority conditions. One could argue that this is the natural way that the market works, but is it a just, or even intelligent, approach to healthcare?

Diseases like Ebola bring this issue into the public eye and arguably provide an opportunity for a broader debate about the pharmaceutical industry and its priorities and near monopoly over life on the planet. Unfortunately, in the contemporary media moment, we are more likely to hear the Obama administration somehow blamed for the minor outbreak (and, given sufficient time, maybe for the disease itself (as a young Muslim visiting Africa)).  But forgoing the bigger issue for a moment, what can be done to stem a disease that could kill millions? Do we simply accept that a pandemic could ravage human populations not only in the poorest countries but across the globe? Do we hope the CDC can control the growing dangers of rare diseases showing up inside our borders, given the continued expansion of globalization? Or can national government or international bodies find a way to push companies to find a cure? Two possibilities exist to address this troubling situation: 1. Subsidize research into potential cures or 2. Create a competition. It turns out, the later is the better option, as long as the competition is perceived as fair and the rewards are large enough to create sufficient incentive. (The New Yorker).

Let’s hope the U.S. government and global bodies start to create these incentive programs, not only for Ebola but for all of the biggest healtcare issues facing humanity today. Don’t hold your breath … or maybe, do!

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