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Sick and Poor? Drug Researchers Aren't Interested

Research studies are not just concentrated by income, they're concentrated according to where researchers are located.

by Michael Byrne
Apr 7 2014, 12:20pm

Photo by US Army

This article originally appeared on MOTHERBOARD.

You know this already, without any study to prove it: corporations that make, market, and sell drugs focus on higher-income markets. I can't even really say that's a failing of those corporations, who are after all corporations and exist to maximize profits (at the expense of ethics), personhood or no. It's a failing of governments, more accurately, for not funding medical research adequately or in the absence of that funding passing laws that force drug-makers to be equitable. That's not unreasonable — in a climate of aggressive patent expansion, drug companies will make lots of money either way.

But, in the meantime, they will continue to do what corporations do just by definition, which is chase dollars where they are. A University of Chicago report out last week outlines how exactly that disparity manifests across the globe. Some of it is obvious just to the naked eye, and you can see it readily in magazine and TV advertisements pushing erectile dysfunction pills and ask-for-it-by-name painkillers, among other drugs largely targeted at the various maladies of old-age. (Direct-to-consumer marketing is its own ugly issue.)

Pursuing drugs benefiting mostly an elderly population is essentially a stand-in for pursuing drugs benefiting a first-world population, where people live a long time and die slowly of things like cancer, COPD, or heart disease (to name the three biggest killers). In the developing world, people die much younger, hit quickly by infectious diseases like cholera, hepatitis, and malaria (or, recently, the Ebola virus). After examining some 4 million different med studies, the Chicago researchers found that for every $10 billion in wealth lost to a disease—found by multiplying a metric known as the local disease burden by a country's wealth — the number of articles on that disease rose by 3 to 5 percent. Again: not surprising.

What may be startling, however, is that it gets much worse. Research studies are not just concentrated by income, they're concentrated according to where researchers are located. "Health researchers are sensitive to problems they are treating, to problems around them, to Grandma's problems," noted lead author James Evans in a press release. "Countries want to fund research that burdens their populations. Where this leads to inequality in health knowledge is that the disease burden of rich and poor countries are different, and that rich countries obviously produce much, much more research." That's an effect that should extend well beyond Big Pharma to university and other public/quasi-public labs.

So, with relatively few local researchers, the developed world is damned doubly and the research rift grows wider. The additional finding that per-country spending rose 75 percent per 10 million years lost to a particular disease within that country then means little outside the developed world. The Chicago team calls the situation in the developing world "double jeopardy," as it experiences the highest health burdens via diseases studied the least. Perhaps the most telling (or damning) finding is that, for studies involving either animals or randomized controlled trials, there is an inverse relationship between the global health burden of a particular disease and the number of studies dedicated to that disease. That is, the diseases that harm the human population the most across the entire globe are studied the least.

The need to dramatically increase spending on medical research in the developing world is obvious, but the Chicago team makes one not-so-obvious addition to that. More money needs to be spent within those countries on research. It's not enough to study a developing world illness in a developed world lab. To do the most good, money needs to be exported in addition to research.

"Often it is said that we know all that we need to know—all that could be known—about many diseases and health challenges faced in the developing world," Evans said. "But repeatedly biomedical researchers find that this 'knowledge' doesn't always translate into reasonable and effective treatments for patients in resource-constrained environments. In short, we need to know more."