The business of medicine…

In my previous blog I discussed the business of science  and why science itself is not,  and should never be, considered a business.  Today, as we see the widening Ebola epidemic spreading throughout West Africa I find myself thinking the same thing about medicine.

Medicine is not a business…

As in science,  there are businesses surrounding medicine.  Big pharma and biotech being far from the least among them.  As  I pointed out before, the science of pharma and biotech must not mix with the business unless you want to be buying hi-tech snake oil when you go to the pharmacy.

But there is another component here, often overlooked and currently underfunded even in developed nations:  the role of a strong public health program and the public funding for basic research.

Pharma & biotech need the public sector in order to thrive…

While big pharma and biotech serve a vital function in the development and production of new drugs, their very nature prevents them from being on the bleeding edge of basic research. They have an obligation to themselves and their shareholders to make a profit leaving basic research out of their realm. The private sector fills that gap and provides pharma with the seed corn for the products that will shape the future of medical care.

The supply-side privatization movement…

In recent years supply-side economic philosophies combined with the financial crisis of 2008 have created a perfect storm for basic biomedical research.  Budgets have faced a hatchet job and this has weakened both public health and basic research here and across the pond in Europe. The WHO (World Health Organization) and the CDC (Center for Disease Control – USA) as well as the NIH (National Institute of Health – USA) have faced death by thousands of small cuts. It is  to the point where the careers of entire generation of scientists have been jeopardized.   Anyone graduating with a doctorate in any discipline of biomedical science is facing a grim to almost impossible job market.

Traditionally, the public and private sectors have something akin to a marriage, but to be successful, they need to work together and be equal partners. Each depends on the other to do what they do best.  But when the power base and money shift too far towards one side, problems arise.

Enter Ebola…

The last thing our struggling public health infrastructure needed was a crisis.  Yet this is exactly what we got.  The initial response by the WHO was sluggish at best.  This slow response allowed the epidemic to gain momentum and has been attributed to budget cuts and the loss of key professionals who would have led the charge of organizing a response.

Biotech to the rescue – sort of…

A collaboration between biotech firms  Mapp Biopharmaceutical, LeafBio and Dreyfus Inc in cooperation  with the US government and the Public Health Agency of Canada developed Zmapp.   Zmapp is the secret  cocktail of monoclonal antibodies that was given to  Dr. Kent Brantley and Nancy Writebol that may or may not be responsible for their recovery.

Monoclonal antibodies are big business for biotech because they are expensive and can bring in the big bucks.  It is therefore no surprise to me that biotech was working on such a treatment.  Even though Ebola impacts primarily  people of the third world, the potential for rich profits is there.

Monoclonal antibodies are to be given once the wheels have come off the train.  It can not prevent or contain outbreaks, its role is to treat those who are already infected.

An ounce of prevention is worth a pound of cure…

So why not the same enthusiasm for a vaccine?  In spite of the fact that Ebola is a dangerous virus with up to a 90% mortality rate, requiring BL4 (biosafety level 4)  containment, there is no vaccine in the immediate pipeline.  Instead, the first product to the rescue was expensive and experimental monoclonal antibodies.

Why did this happen? Because ongoing vaccine research was being hampered by a lack of funding.  Aljazeera reported  in early August that  a vaccine that protected monkeys from several strains of Ebola had been developed 4 years ago.  Although the results were extremely promising,  the  work was not taken beyond these initial steps.  Progress stopped at the exact point where the public sector passes the baton to the private sector

Falling through the cracks of the public/private sector marriage…

Unlike monoclonal antibodies that have a rich payday, vaccines are the poor stepchild to such a lucrative venue.  They are expected to be inexpensive and admittedly, the current environment makes any problems associated with them to be a minefield of litigation.  The ROI just isn’t there for the private sector to act.

As of now, Ebola has the attention of the industrialized world and US and an experimental vaccine is on the fast-track according to Anthony Fauci of the NIAID (National Institute of Allergy and Infectious Disesase).

The bottom line…

From a public health perspective, the vaccine should have been  in the front lines of research and not relegated to the back-burner -behind monoclonal antibody therapy.  After all, job-one is containment. If the virus is contained the need for further treatments is limited.  Resorting to the most expensive possible treatment imaginable as your first line defense shows the cracks in the system.

The interests of the public and the interests of the private sector are often at polar opposites.  Supply-siders who believe the private sector solves all problems should take note…A strong, well funded public health system is absolutely essential to our collective welfare.  Time to get behind it.

© 2014 – RGHicks – http://ReinnovatingAmerica.com – All rights reserved.

 

 

 

 

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