Tag: india

Big Pharma cannot ignore developing world diseases anymore

Akshat Rathi1 Comment

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.

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

Akshat Rathi2 Comments

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.

Wear masks and plant trees—air pollution is killing us

Akshat Rathi1 Comment

India ranks 174th on air quality among 178 countries, according to the 2014 Yale Environmental Performance Index. Particulate matter in the air of 180 Indian cities was six times higher than the standard set by the World Health Organisation (WHO). Indoor and outdoor air pollution are now the third and fifth leading cause of death in the country, causing more than a million premature deaths ever year.

The main pollutants in the air are sulphur dioxide, ozone, various oxides of nitrogen and particulate matter of different sizes. Breathing polluted air slowly leads to diseases that affect the lungs, the heart and even the brain. That pollution causes these diseases may not be immediately evident, but the WHO’s large data collection points unequivocally to the causal link.

All shook up

What is probably more troubling is that the problem has suddenly got worse. The number of deaths caused in India by outdoor air pollution has increased six-fold since 2000. A number of factors have contributed to this rise: reliance on and increased use of coal-powered power plants, growing number of vehicles, improper urban planning and poor enforcement of regulations.

Just like clean water, clean air is a public utility and governments have a duty to ensure that these are available to its citizens. Central and state governments have been making some changes, but they haven’t helped much. In Delhi—judged by the WHO in May 2014 as the city with the most polluted air among 1,600 cities across 91 countries—the government has tried to implement various schemes, such as the use of natural gas for public transport, but without much improvement in air quality.

Air pollution has a negative effect on the economy, too. According to the World Bank, its ill-effects cost India ₹ 3.3 lakh crores annually, which is 3% of the gross domestic product. Not enough is being done to address the problem.

A little less conversation, a little more action please

I believe the problem is so huge that it is too late to wait for government’s actions to protect our health. Fortunately, there are steps that citizens can take to deal with air pollution, which can significantly increase the quality of the air we breath.

If you or someone you know burns wood for the purpose of cooking or heating water, you could improve your health by stopping or altering this practice. Most cookstoves of this kind do not burn the wood efficiently, releasing very harmful particulate matter. If you cannot afford to replace wood with natural gas for cooking, the cheaper option would be to buy a subsidised improved cookstove available from government outlets.

The easiest way to deal with outdoor pollution is to wear a mask. Look for N95 masks which are relatively easy to find and fairly cheap. Whatever mask you buy, ensure that it covers your nose and mouth fully, because any air gaps will render the effort ineffective. Masks are not as uncomfortable as they look, but they are definitely not stylish. Yet, by wearing a mask, you are not just taking care of your health but also making a public display of protest against the government whose duty it is to ensure that air quality be improved.

The final thing you can do to deal with outdoor pollution is to plant trees, specifically outside your house. A recent study by scientists at Lancaster University showed that a line of young birch trees outside the house can cut particulate matter entering the house by half. Trees are also highly effective when planted along busy roads, because they can absorb not just carbon dioxide but also ozone, sulphur dioxide, nitrogen oxides and carbon monoxide.

For too many years we have taken the air we breath for granted. We have ignored the risk that the tragedy of the commons could afflict this abundant public utility. Let’s hope we can fix it before it’s too late.

First published in Lokmat Times.