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May 2003
SARS and the Free
Market
The good news about SARS is that it took only a month to isolate
and identify the virus, not the years it took for AIDS.
How did it
happen so fast? Dr. Klaus Stöhr, the World Health
Organization coordinator of the SARS research team, said, “The
people in this network have put aside profit and prestige to work
together to find the cause of this new disease and to find way
new ways of fighting it. In this globalized world, such collaboration
is the only way forward in tackling emerging diseases.”
SARS may well be the harbinger that provokes us to re-examine
a health research enterprise that relies so heavily on the assumptions
of a free market to translate its products for the benefit of society.
After World War II, the American scientific enterprise moved out
from under close federal control and into the private and academic
sector with support, but only broad direction, from the government.
Free-market competition in science resulted in the most highly
technological health care in the world.
What have we learned about how the market translates health research
into action in the course of this 50-year experiment with the free
market?
- The juice
has to be worth the squeeze. If SARS doesn't develop into a
big enough epidemic, or infects primarily poor countries
that cannot pay for expensive new drugs, it will be difficult
to interest pharmaceutical companies in the development of
treatments
or vaccines.
- The
wallet has to be under the lightpost; i.e, the market falls
short
when it limits where solutions are sought. We've suspected
for decades that aspirin, and now aspirin-like anti-inflammatories,
are linked to cancer prevention. Why the lag between the
initial observations and the eventual studies? The answer is
as subtle
as, well, cardiac arrest. Aspirin is generic, cheap and does
not generate profits to support drug company research into
its cancer-preventing
properties.
- It
takes more than a vaccine — it takes vaccinations.
Development of a vaccine is only half the equation for containing
a disease. Getting the vaccine into the arms of the right people
is another — regardless of whether those arms are attached
to people living in packed Hong Kong tenements or Park Avenue
penthouses.
Health research graduated from government to the free market 50
years ago. But the issues that faced us then are different now.
First, infectious disease is no longer regional or owned by the
poor; it gets on airplanes and can threaten the world in days.
Second, the graying of America means the biggest demand for health
care at home is now for treatment of chronic, not acute, diseases.
We need to find incentives to develop and deliver cheap tools
to fight unprofitable diseases like AIDS, measles and diarrhea
that kill tens of millions of people worldwide. We also need to
invest in approaches to prevent and manage the chronic diseases
like cancer, heart attack, stroke and diabetes that plague modern
America today.
Let’s
hope that SARS continues to set precedents for researching and
treating
these less sensational but even more deadly diseases.
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