Big Pharma cannot ignore developing world diseases anymore

We may not realise this but a lot of us today live better lives than those of medieval kings. Most people then died under the age of 40 and lived in constant fear of contracting diseases. The worst killers were infectious diseases, such as plague, caused by bacteria and spread by poor sanitation. The last century has seen us banish these evils with the help of antibiotics and easier access to better hygiene.

Sadly the benefits of medicine haven’t been spread evenly throughout the world. In developing countries, there remain many diseases that were eliminated in the developed world decades ago. One of the biggest causes for this is that Big Pharma finds it unprofitable. Because it is not the rich world that they affect, the economics of drug discovery – which admittedly requires huge investments – to treat poor people’s diseases do not work out in favour of the pharmaceutical industry.

A matter of timing

Alexander Fleming’s discovery of penicillin – the first antibiotic – in 1928 was an accident, but the world had been waiting a long time for something like it. The timing couldn’t have been better. By then the pharmaceutical industry had begun to systematically search for new drugs. Governments had recognised the role that new medicines could play in improving health and, in turn, economic productivity. By the time World War II started, they had set up the right safeguards to allow the industry to mass produce drugs. Historical records suggest that Nazi Germany’s inability to produce enough penicillin may have played a role in their eventual loss.

As the decades rolled on, pharmaceutical industry, such as German company Bayer and British company Glaxo, grew bigger and bigger. Today, a bunch of these giants are collectively referred to as Big Pharma. And all of them have most of their operations in the rich world.

While India has a pharmaceutical industry, which is increasingly playing a bigger role in the global market, drug development is too big a challenge for it. That is because the price of drug development has been rising quickly. Today the development of a single drug can cost billions of dollars (lakhs of crores of rupees). And this has created a negative cycle, where Big Pharma mostly invests in the development of those drugs that will provide them a return on the billions of dollars they invest to develop it. The upshot is that poor people’s diseases are neglected.

Ignore no more

So severe has this neglicence been in recent years that the World Health Organisation now lists 17 diseases under a priority list of “Neglected Tropical Diseases”. These include dengue,chikungunya, rabies and leprosy. Even beyond that list, however, other diseases remain under-researched. These include malaria, tuberculosis and diarrhoea. All these don’t exist in the developed world, but cause millions of deaths in developing countries.

This must change. There are moral reasons for why letting millions die from preventable causes is wrong, but the nature of modern corporations is such that moral reasons work only in extreme circumstances. Fortunately, there is now a growing economic case. As markets in the west become saturated, pharma industry is looking to the emerging world, especially countries such as India and China, for a new market.

As they start coming they will first cater to the rich and the growing middle class, but these companies won’t be able to survive without serving the poor too. For instance, India’s patent laws force Western firms to provide compulsory licenses or provide their own drugs at cheaper rates, if the country’s courts find the drugs are essential but unaffordable. Instead of giving up their exclusivity, many firms are choosing the latter option. Profit margins will fall but sale volumes will rise.

With such changes underfoot, it is now time that Big Pharma also look to cater to poor people’s diseases. While the economic case to profit from such work is becoming stronger, governments could help through subsidies to attract these companies to begin their work sooner. The expertise and knowledge that they will bring could revolutionise healthcare for the poor.

First published in Lokmat Times.

Curious Bends – big tobacco, internet blindness, spoilt dogs and more

1. Despite the deadly floods in Uttarakhand in 2013, the govt ignores grave environmental reports on the new dams to be built in the state

“The Supreme Court asked the Union environment ministry to review six specific hydroelectric projects on the upper Ganga basin in Uttarakhand. On Wednesday, the ministry informed the apex court that its expert committee had checked and found the six had almost all the requisite and legitimate clearances. But, the ministry did not tell the court the experts, in the report to the ministry, had also warned these dams could have a huge impact on the people, ecology and safety of the region, and should not be permitted at all on the basis of old clearances.” (6 min read, businessstandard.com)

2. At the heart of the global-warming debate is the issue of energy poverty, and we don’t really have a plan to solve the problem

“Each year, human civilization consumes some 14 terawatts of power, mostly provided by burning the fossilized sunshine known as coal, oil and natural gas. That’s 2,000 watts for every man, woman and child on the planet. Of course, power isn’t exactly distributed that way. In fact, roughly two billion people lack reliable access to modern energy—whether fossil fuels or electricity—and largely rely on burning charcoal, dung or wood for light, heat and cooking.” (4 min read, scientificamerican.com)

3. Millions of Facebook users have no idea they’re using the internet

“Indonesians surveyed by Galpaya told her that they didn’t use the internet. But in focus groups, they would talk enthusiastically about how much time they spent on Facebook. Galpaya, a researcher (and now CEO) with LIRNEasia, a think tank, called Rohan Samarajiva, her boss at the time, to tell him what she had discovered. “It seemed that in their minds, the Internet did not exist; only Facebook,” he concluded.” (8 min read, qz.com)

+ The author of the piece, Leo Mirani, is a London-based reporter for Quartz.

4. The lengths to which big tobacco industries will go to keep their markets alive is truly astounding

“Countries have responded to Big Tobacco’s unorthodox marketing with laws that allow government to place grotesque images of smoker’s lung and blackened teeth on cigarette packaging, but even those measures have resulted in threats of billion-dollar lawsuits from the tobacco giants in international court. One such battle is being waged in Togo, where Philip Morris International, a company with annual earnings of $80 billion, is threatening a nation with a GDP of $4.3 billion over their plans to add the harsh imagery to cigarette boxes, since much of the population is illiterate and therefore can’t read the warning labels.” (18 min video, John Oliver’s Last Week Tonight via youtube.com)

5. Hundreds of people have caught hellish bacterial infections and turned to Eastern Europe for a century-old viral therapy

“A few weeks later, the Georgian doctors called Rose with good news: They would be able to design a concoction of phages to treat Rachel’s infections. After convincing Rachel’s doctor to write a prescription for the viruses (so they could cross the U.S. border), Rose paid the Georgian clinic $800 for a three-month supply. She was surprised that phages were so inexpensive; in contrast, her insurance company was forking over roughly $14,000 a month for Rachel’s antibiotics.” (14 min read, buzzfeed.com)

Chart of the Week

“Deshpande takes her dog, who turned six in February, for a walk three times every day. When summers are at its peak, he is made to run on the treadmill inside the house for about half-hour. Zuzu’s brown and white hair is brushed once every month, he goes for a shower twice a month—sometimes at home, or at a dog spa—and even travels with the family to the hills every year. And like any other Saint Bernard, he has a large appetite, eating 20 kilograms of dog food every month. The family ends up spending Rs5,000 ($80)-7,000 ($112) every month on Zuzu, about double the amount they spend on Filu, a Cocker Spaniel.” (4 min read, qz.com)

Genetic testing is all the rage, but its promise is limited

New technologies often take decades to reach Indian shores. Not so in the case of genetic testing. Within 10 years of the launch of the world’s first direct-to-consumer service, genetic testing has found a booming market in India.

Your DNA, unless you have an identical twin, is unique. The idea behind any genetic test is to understand whether the sequence of bases in your DNA have something useful to tell you. Those on offer in India can cost anywhere from ₹1,000 to ₹50,000.

Who’s your daddy?

One of the most popular genetic tests in India is used to test paternity. Be it a doubting husband or a long-lost son, these “peace-of-mind tests” can set the record straight. Their effectiveness is so high that Indian courts have used paternity tests as definitive evidence. Take the example of Congress politician ND Tiwari. In 2008, 28-year-old Rohit Shekhar claimed that Tiwari was his biological father. After a long-drawn battle, the court ordered a paternity test in 2012 and closed the case in favour of Shekhar.

This is how paternity testing works. A child inherits half their DNA from each parent. For the test, DNA samples in the form of cheek swabs are taken from all three individuals. These samples are then treated with restriction enzymes, which cut each DNA at pre-determined places. These cut-up pieces are then suspended in a solution and run through a gel, which lets shorter pieces run faster than bigger pieces. The pieces show up as dark spots on a light background. If the parents are indeed those making the claim, the child’s DNA patterns will appear to be a combination of the patterns of the parents.

This technique, called DNA fingerprinting, was developed in 1984 and has also been used to produce forensic evidence in thousands of criminal cases. Instead of comparing a DNA sample of a child with two others, say, it could be used to compare DNA found in some hair at a crime scene with that of the accused perpetrator.

Not the oracle

Not all genetic tests are so effective at giving useful information though. Many companies market genetic test results as a fortune-telling scroll. They claim that, based on your genetic information, they can predict whether you will get a disease or not. This is far from the truth. At best, genetic testing for health outcomes can be seen as a weather map, where predictions can be true but quite often they aren’t.

Even if genetic testing companies make this clear in their fine print, they haven’t done enough to correct public perception. For instance, a 2010 European survey revealed that nearly half of those asked felt “all children will (soon) be tested at a young age to find out what disease they get at a later age”.

While certain diseases, such as Huntington’s disease, have specific genetic mutations to blame, most diseases are a combination of environment, lifestyle and genes. There is no “gene for breast cancer”. Genes are indeed powerful, and they influence our appearance, intelligence, behaviour and health. But unlike what the public believes, genes do not determine those outcomes.

These public beliefs matter because they can and will affect policy. After 13 years of debate, in 2008 the US passed the Genetic Information Non-discrimination Act to ensure that insurance providers do not discriminate customers based on their genes. Before the genetic testing market in India explodes to ₹800 crores by 2018, as some predict, we need a similar act to safeguard people’s privacy. And even after that, treat any genetic test results with skepticism and care.

First published in Lokmat Times.