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Op-Ed
The San Diego Union-Tribune (San Diego, CA)

Op-Ed
Published in San Diego Union-Tribune
Apr. 22, 2003

The free market and the SARS virus

By Jessie C. Gruman

When AIDS suddenly appeared, it took more than two years to discover the virus that caused it. It took five months to identify the bacterium that caused Legionnaire's disease and just as long to track down the viral source of New Mexico's hantavirus outbreak a decade ago.

This year, it took but a month to isolate and identify the virus responsible for the explosion of SARS cases, thus advancing the timetable for discovering new drugs or vaccines to fight this new disease.

How did it happen so fast? "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," says Dr. Klaus Stoehr, the World Health Organization coordinator of the SARS research team. "In this globalized world, such collaboration is the only way forward in tackling emerging diseases."

Let's hope that the forces mobilized against SARS continue to set precedents for researching and treating other less sensational but even more deadly diseases.

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.

But the match between a competitive market economy and the changing health needs of the nation operates in increasing disharmony. Our highly developed approach to translating knowledge into action has not resulted in the longest life expectancy or best health outcomes 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. The Department of Health and Human Services convened pharmaceutical companies two weeks ago to encourage their interest, but the companies' response, apparently, was similar to their response to government appeals for research on bioterror and biowarfare: "Why should we risk investing in finding solutions to a problem that might not ever amount to a hill of beans?"
  
  
• The wallet has to be under the light post; i.e, the market falls short when it limits where solutions are sought. In the 1970s, researchers made chance observations that people with arthritis seemed to have a lower incidence of cancer than those without. Ten years ago, an obscure paper from Sweden described a study in which patients with end-stage colon cancers were given either a placebo or aspirin, and the patients in the aspirin group lived twice as long. In recent weeks, published studies linked aspirin-like anti-inflammatory drugs with the prevention of colon and breast cancer.

Why the lag between the initial observations and the eventual study of the relationship between aspirin and cancer? 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-prevention 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.

The free market controls only the price of a solution. It takes political will to properly define the question in the first place and then deliver the answer — the vaccines or treatments to the right people at the right time.

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.

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. 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 and to invest in approaches to prevent and manage the chronic diseases like cancer, heart attack, stroke and diabetes that plague modern America today.

Jessie C.Gruman is a social psychologist and president of the Washington-based Center for the Advancement of Health, a nonprofit institute dedicated to translating research into practice and policy.