When money gets involved, good medical ideas suffer

I read an interesting link via Reuters about how students have developed a smart phone application with a microscope attachment to diagnose malaria.

The article shows a picture of a child at risk somewhere in Africa.

This is a great idea, and one that can go a long way to help people who really need it.  But the last word from the project’s software engineer in the article was the one that was most revealing.

“From different conversations we’ve had with investors, we feel that this definitely is a money-maker,” he said.

And that profit motive stuck in my throat, spoiling what up until that point had been a feel-good article.  I want to be Bill Gates too, but as far as I can tell profiteering in healthcare has messed things up for us all.

Will the team develop the device even if it isn’t a good money-maker?  Will “major life saver” be enough?  Even if these are African, South American and Asian lives, and not North American lives?

Will investors still back development on this basis?  Even if the project has just a break even financial prospect, will the possibility of saving lives make it worthwhile?  Or will the project have to depend on financing from billionaires who have found that giving away their money is the best way to enjoy it?

We’ve been down this road before in medicine. Lack of money-maker potential means pharmaceutical companies have not invested in developing new antibiotics.  There are very few new molecules in development, despite rampant growth of bacterial resistance. As a result, we face a slide of 70 years back to a situation where bacterial infections nowadays considered mild can and will kill.  An antibiotic taken for five days in a year is a poor prospect for a pharmaceutical company compared to a new drug taken every day for years on end for Alzheimer’s or Parkinson’s disease.  Antibiotics are just not money-makers.  Let’s see where this takes us in ten years — super bugs and no means of treating them.

The dream of medical marijuana in a tablet form for the considerable positive medical effects without the negative has little chance of being realised — there is little prospect of making money in the development.  A drug company would battle to get a patent and be able to protect its investment.  So as much promise as medical cannibis has, that promise will go unrealised unless research is funded by non-profit organisations.

Primary care practice is just not a money-maker, whereas specialist practice is.  Never mind that PCPs are needed as much as specialists if not more.  It is not a good investment, and that is one of the reasons why so many doctors like me left to specialize, and few are choosing primary care as a career path.

Operative procedures are money-makers.  That is why surgeons like to operate.  No matter how ethical you are, there is a powerful bias towards operating when the indications are marginal. Conservatism does not pay as well as surgical aggression.

High tech in medicine is a money-maker.  Throw millions into development of new scanners and imagers and interventional procedures, and see the costs of healthcare rocket.  The primary benefit of high tech development in my opinion is to make money in selected markets, not to improve healthcare on a wide scale.

So, being a potential money-maker, how will this new device be marketed and more importantly, priced, considering the areas of greatest need are all brutally poor?  The device may cost as much as or more than the smart phone itself.  Nothing labelled as “medical” is cheap, particularly when intended as a money maker.  And being expensive, the chances of reaching the hands in significant numbers of those that can use it to save lives in Africa, Asia and Central America are relatively slim.

Malaria last year killed more than 850,000 people that we know of, and many more who were not recorded, 91% of whom lived in Africa, and 85% of whom were children under the age of five.

This idea is great and deserves to succeed.  Whether this, and others like it, will make a real difference depends on the motives and desires of those with the will and means to push development forward as an ethical and technical advancement for mankind, and not just as a money making medical device.  Or else that tragic figure of 850,000 will remain unchanged.

Martin Young is an otolaryngologist and founder and CEO of ConsentCare.

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