Alessandra Tomasi received her B.A. from Cornell University and is now a first year medical student.
Tropical diseases directly affect more than one billion people in the developing world each year . Neglected Tropical Diseases, or NTDs, are defined as chronic, debilitating infections that are especially endemic in regions of severe poverty and poor sanitation, and for which treatments and preventions remain largely overlooked . Conditions such as chagas, dengue, lymphatic filariasis, and schistosomiasis represent a small fraction of such infections, yet they account for millions of afflictions each year . Despite the staggering statistics, however, few effective treatments have been made available to plagued populations. Largely found in tropical communities with unsafe drinking water, poor sanitation, and substandard housing, these populations remain socially and medically marginalized on a global scale . In fact, each year only a small fraction of medicines introduced to market by multinational pharmaceutical companies are specifically intended for treatment of tropical diseases in the Third World, and minimal returns on investment have only contributed to keeping this distribution exceptionally low. As the translation of lab and clinical progress into the development of new treatments continues to be a slow and costly process, advancements in the field of tropical pathology thus remain largely unavailable to the poverty-stricken populations that need it most . This disparity in access to proper medical care ultimately imparts burdens not only on the health but also the economic development of susceptible low-income countries.
Much of the burden set by tropical diseases can be prevented with known technologies; however, drug companies have had little incentive to spend millions to develop the necessary drugs and bring them to markets that need it most. In fact, the past decade has only targeted 3.8% of the 756 new drugs approved in the US and Europe to treat diseases in the developing world . Additionally, in 2012, the US government allocated over $7 billion to global health programs; however, only 1.3% of this was invested in NTDs . As a result, millions of people each year, most of them in Third World tropical regions, die of curable and even preventable diseases simply because it is not cost-effective to properly treat them.
The low quality of medical infrastructure in developing nations, coupled with inadequate levels of foreign aid, has impacted poverty-stricken communities beyond the scope of health and medical care . Disease slows growth and intellectual development in children and adolescents, and impedes productivity for working adults. Quantitatively, the economic burden caused by NTDs is expressed through the loss of disability-adjusted life years (DALYs), or the years of healthy life lost as a result of disability or premature death. In total, the 17 categorized neglected tropical diseases collectively account for a loss of approximately 46-57 million DALYs .
To understand the burden of disease on a more fundamental level, consider the specific case of lymphatic filariasis. It has been estimated that this particular NTD, which mostly affects rural communities in India, causes each infected patient to lose about 11 years’ worth of productivity . This corresponds roughly to a loss of $50 per year per individual, equivalent to 15% of one’s income. In total, it has been estimated that India alone loses approximately $1 billion per year in GDP to lymphatic filariasis .
Similarly, the parasitic infection onchocerciasis exhibits analogous destructive economic effects on plagued populations . Particularly endemic in African nations, the NTD accounts for over one million cases of visual disability and blindness, and is the world’s second leading cause of infectious blinding . Its debilitating effects cause infected patients in rural areas to abandon work, thereby dramatically reducing agricultural output. In Africa alone, onchocerciasis is responsible for over 640,000 disability-adjusted life years (DALYs); worldwide, it is responsible for nearly 1.5 million .
Because NTDs impact communities that are already marginalized on a global scale, the additional economic strains they impart greatly inhibit these populations’ ability to move out of poverty . Sustainability efforts in developing nations continue to be stunted, and communities around the world remain unable to climb the economic pyramid. With almost one-sixth of the world’s population affected by the lack of access to proper medical care and to the resources necessary for prevention and treatment of tropical diseases, the consequences of NTDs transcend their direct impact on individual health. As a result, it is important to shift from viewing these diseases solely within the context of individual health, and instead towards a view that also includes global, social, and economic contexts. With tropical diseases disproportionately affecting the poorest of populations, NTD awareness must be integrated into a broader social agenda to increase advocacy and strengthen global aid. Expanding financial resources alone will not solve the issue. By diminishing opportunities to succeed, NTDs reinforce cycles of poverty among the world’s most disadvantaged populations. Improvements in infrastructure and drastic changes in regulatory authority as well as government spending are slowly beginning to improve the situation; however, there remains a lot to be done.
1. Vogel G. Tackling neglected diseases could offer more bang for the buck. Science. 2006 Feb 3;311(5761):592-3.
2. WHO: Global Burden Data 2004: DALYs by age, sex and cause for the year 2004 http://apps.who.int/ghodata/?vid=110001. (Accessed November 11, 2011).
3. Hotez PJ, Fenwick A, Savioli L et al. Rescuing the bottom billion through control of neglected tropical diseases. Lancet 2009; 373: 1570–75
4. U.S. Global Health Policy: Fact Sheet: The U.S. Government Response to Global Neglected Tropical Diseases. May 2012 http://www.kff.org/globalhealth/upload/7938-03.pdf
5. K.D. Ramaiah, P.K. Das, E. Michael and H. Guyatt. The Economic Burden of Lymphatic Filariasis in India. Parasitology Today. 2000; 16 (6); 251-253.
6. Seymour J, Kinder M, Benton B. “Controlling Onchocerciasis (River Blindness) in Sub-Saharan Africa,” in Case Studies in Global Health: Millions Saved. Sudbury, MA: Jones and Bartlett Publishers, 2007.
7. Christopher J. L. Murray and Alan D. Lopez, The Global Burden of Disease, Harvard University Press, 1996.
8. Frew SE, Liu VY, Singer PA. "A business plan to help the 'global South' in its fight against neglected diseases." Health Aff (Millwood). 2009 Nov-Dec;28(6):1760-73
Alessandra Tomasi received her B.A. from Cornell University and is now a first year medical student.
A major barrier in medical access worldwide is the high price of drugs. Especially in developing nations, millions of people do not have access to the pharmaceuticals they need because they, or at times even their government, cannot afford them. A significant contributing factor to this obstacle lies in patent law and distribution [1, 4]. Laboratory advancements that are translated into new drugs, vaccines, and other tools for pathogenic prevention and treatment are afforded a seal of exclusive rights, thereby eliminating any form of open competition that could drive prices down to more affordable levels . Such high prices result in life-saving drugs that are too expensive for many in need, leaving millions of people around the world unable to afford medicine for treatable conditions .
When pharmaceutical companies develop a new drug, they are awarded a patent, which grants the group exclusive rights to make, use, and distribute the medication on their own terms for 20 years [1, 2]. The most widely acknowledged function of a patent is thus its role as a financial incentive, making it possible for innovators to obtain sufficient returns for their research . This incentive, though lucrative and advantageous to developed nations, according to the WHO, poses a threat to the advancement of those that are instead less industrialized. That is, whereas developed countries that have vast capacities for innovation benefit from such a system, developing nations that lack such technological resources and infrastructure are unable to keep up and sustain their own growth . These populations therefore remain in reinforced cycles of poverty, with little access to vital medications.
The unequal access to pharmaceuticals due to monopolies over drug development has been the subject of numerous negotiations and debates in key international forums, including the World Trade Organization, the World Health Organization, and the World Intellectual Property Organization [3, 4]. These discussions draw on several facets of public policy, including international trade law, intellectual property law, health law, and human rights and ethics . According to the World International Intellectual Property Organization (WIPO), fiscal and commercial incentives provided by the patent system do not ensure the development of new products in certain areas, especially with respect to neglected diseases that plague countries of poverty . As a result, policymakers must continuously seek a balance between the rights of patent owners and the overall public need. Since drug research and development is an incredibly expensive process that requires vast and long-term investment, the patent system exists to offer scientists a means for pursuing innovation. At the same time, however, accessibility to society remains an issue.
Current pharmaceutical ownership and licensing policies thus pose threats to health crises in developing nations, in that they prevent access to essential medicines by providing incentives for drug development based almost exclusively on market-based needs . Drug companies have little incentive to spend millions to develop necessary drugs and bring them to the markets most in need, if these markets cannot in turn provide monetary gain [4, 5]. Consequently, while a patent system should guarantee that innovations be beneficial to the public as a whole, the vast majority of drug research and development is instead focused on diseases that more commonly affect people in developed countries— thereby neglecting the diseases that primarily affect people in developing nations .
South Africa provides a powerful example of an especially ill-structured patent system. Currently under fire by many activist groups for its adverse structure, according to the Doctors Without Borders Access Campaign, the nation has incorporated such lenient patent laws that private pharmaceutical companies benefit financially while leaving patients unable to pay the excessive pricing on drugs . South Africa’s current system, in fact, allows any minimal change in a specific drug— even one that provides no actual improvement to the existing medication— to be easily re-patented for an additional 20 years following its original stamp, thereby furthering its monopolized distribution and pricing. Rather than strengthen the health care system, therefore, South Africa's patent system reinforces a cycle where necessary medications remain out of reach for most . This is especially a concern today, given this year's rapidly proliferating drug-resistant tuberculosis bacteria: one of the few drugs that is actually known to successfully treat this strain— Linezolid— is marketed at such a high price due to patent protection, that thousands of South African citizens dependent on their nation's health care remain unable to purchase the drug necessary to treat the rampant disease .
Law should be used to accelerate medical treatment, not inhibit it. The artificially high prices imposed by South Africa's current system reflect a gaping hole in the process of drug development and distribution that unfortunately extends across several nations worldwide. Overall, it appears that in terms of pharmaceutical availability, either no product exists, or not enough do at reasonable enough prices for patients to actually afford them. These circumstances thus call for innovations in the patent system itself. How, though, does one stimulate innovation, particularly in the developing world, such that nations and communities in need of drugs no longer rely solely on pharmaceuticals derived from external and thus expensive research? As summarized by the Science and Technology Advisor for Africa's New Partnership for Africa's Development (NEPAD), “scientific and technological capacity for health cannot be reduced to equipment, funding, and number of health scientists and technicians” . That is to say, the capacity for a nation to build its own innovation lies in a carefully mapped arrangement of policies, skills, and communication, a pursuit that begins with the careful re-organization of patent law.
1. Elliott R, Bonin MH. Patents, International Trade Law, and Access to Essential Medicines. & Médecins Sans Frontières Canada, May 2002.
2. Reisman J, Physicians and Surgeons as Inventors: Reconciling Medical Process Patents and Medical Ethics, 10 HIGH TECH. L. J. 355, Section II.C (1995)
3. Commission on Intellectual Property Rights, Innovation and Public Health. World Health Organization. Library Cataloguing-in-Publication Data. May 2005.
4. Medcins Sans Frontières. MSF welcomes Brazil Parliamentary Committee recommendation to reform patent law. October 2013.
5. World Intellectual Property Organization, Public Health and Patents. March 2009.
6. Twagirumukiza, M. Drugs and Diagnostic Innovation in the Developing World: A Review and Call For Debate. The Science Advisory Board, 2011.
7. Medcins Sans Frontières. Fix the Patent Laws: A grassroots campaign in South Africa could change all that. October 2013.
Alessandra Tomasi received her B.A. from Cornell University and is now a first year medical student.
In many areas around the world, particularly urban neighborhoods marked by poverty and social marginalization, individuals remain in a state of medical detachment. Patients do not know why they are taking specific medications, parents do not understand the implications of lifestyle choices on the development of their children, and the public remains largely unaware of how to deal with the collateral sanitation and health repercussions brought by unpredictable events such as natural disasters. As epigenetic, psychological, and physical health studies make it increasingly apparent that everyday decisions hold lifelong implications, the value of personal and societal education augments. With so many health issues resulting from misconception and lack of awareness, an industry that disseminates information can and should therefore be used to its maximum potential. Today especially as communication through a variety of media continues to promote major changes around the world, the same tools should be utilized in spreading awareness, understanding, and appreciation for the lifestyle choices, preventions, and treatments that shape individual health.
Without information, situations stagnate. On local, regional, and global levels, a lack of education does nothing but reinforce cycles of ignorance and quiescence. It is therefore in every individual’s best interest to remain abidingly aware of the impact their choices make on their health. However, medicine is inherently an esoteric profession, and as diseases increase in complexity, understanding diminishes. Medicine now works in a way it never previously did, with unprecedented technologies and an unparalleled understanding of the human body. Medical journalism can rather provide the tools necessary to establish transparency and clarity within the contexts of natural or man-made disasters, drug development, technological advancements, and injury. The often-overlooked issues are those that require the brightest spotlights. Advancements in medicine and developments in diagnostics and treatments are in fact no more important than the tools needed to communicate this growth in scientific knowledge to the public as a whole.
Our society relies on media each day to stay informed— 83% of Americans, in fact, obtain news in one form or another on a daily basis . Media has been an immensely successful tool in galvanizing social and political change, and its potency should thus be applied to medicine as well. Spreading individuals’ success stories and tales of failures collectively provide viewers with perspective on various medical or health issues. It has been shown that 70% of cancer patients turn to media for information . In the same way, advertisements, documentaries, interviews, public dissemination of scientific studies, and media campaigns have played an overwhelmingly crucial role in promoting and reducing tobacco use in light of confirmed causative links between smoking and cancer over the past few decades [2, 3]. Who is to say the same revolution of understanding will not occur, for example, with medical marijuana use?
In one of today’s most split medical debates the media has already begun to play a significant role in delineating the scientific and political implications of marijuana use. Since its foundation, the media has been largely responsible for the creation and promotion of image . And, historically, marijuana has been associated with unruly and deviant behavior, as well as anti-drug use campaigns . This lens has influenced the public perception and overwhelming rejection of marijuana as a purely unlawful drug. Recently, however, medical testing and research has isolated health benefits of the plant, citing especially its potency in pain reduction and seizure control . A shift in media coverage of the drug has accompanied this change in prospective marijuana use, as interviews, specials, and documentaries have begun to investigate the potential of marijuana in the medical community . Editorials and expository headlines have asked and answered the most basic of questions in an attempt to double down on the true ramifications of weed use: how does it get into your body, and what are the compounds found within that induce a high, or treat pain, or mend neurological abnormalities? Can individual chemical components be isolated to create targeted pharmaceuticals, or must the entire plant be included for efficacy? What are the behavioral consequences, and how heavily do they weigh in terms of drug benefits?
In this way, media coverage possesses the ability to influence perceptions of both consumers and medical professionals. Dr. Sanjay Gupta’s critically acclaimed CNN documentary Weed, for example, provided its 1.21 million viewers with information crucial to educating the public and possibly even redirecting overwhelmingly uncompromising opinions and perceptions of the drug . This particular investigation evolved from covering marijuana’s scientific and chemical foundation to honing in on the widespread struggle to gain its acceptance in the political and health policy worlds . Acting as an educational tool to help pave the way to reshaping the public’s perception of a less-than-conventional approach to tackling human health, this documentary provides a potent example of the expository effects of media on public health perception. It shifts from tackling the overwhelmingly negative social consequences of marijuana use towards seeking to truly understand the medical implications of the drug, as a target for potential pharmaceutical treatment .
All in all, there has been a significant surge in coverage of marijuana-related issues in the media. From the debate over legalization to the economics of contesting drug cartels, headlines have been giving increasingly more attention to marijuana as a national and at times even global issue. In light of policy reforms, journalism helps its viewers follow the shift in understanding of this drug, and in so doing dynamically helps change perception of marijuana as a solely illegal recreational drug to instead understand and embrace its medical benefits.
An understanding of even the most basic medical science provides an individual with the tools necessary to ask the right questions about his or her health. Without proper education and resources, individuals remain unaware of the ever-expanding discoveries in the medical field. The media has proven to be an extremely effective tool in galvanizing social and political change, and through writing, speaking, presenting, and promoting, health and awareness can and should also be spread to keep people informed. Disease does not respect boundaries, and neither should information.
1. Americans Spending More Time Following the News. PewResearch Center for the People & the Press. September 12, 2010. Retrieved from: www.people-press.org.
2. Flora, J. A., Maibach, E. W., & Maccoby, N. (1989). The role of media across four levels of health promotion intervention. Annual Review of Public Health, 10(1), 181-201.
3. Flay, B. R. (1987). Mass media and smoking cessation: a critical review. American Journal of Public Health, 77(2), 153-160.
4. Stryker, J. E. (2003). Articles media and marijuana: A longitudinal analysis of news media effects on adolescents' marijuana use and related outcomes, 1977-1999. Journal of health communication, 8(4), 305-328.
5. Cohen, P. J. (2009). Medical marijuana: the conflict between scientific evidence and political ideology. Part one of two. Journal of Pain and Palliative Care Pharmacotherapy, 23(1), 4-25.
6. Hall, W., & Degenhardt, L. (2003). Medical Marijuana Initiatives. CNS drugs, 17(10), 689-697.7. Gupta, S. (2013). Why I changed my mind on weed. CNN. com, 9.