James Williams' "Medicine: Business Or A Basic Human Right?"

Ho Chi Minh City Hall

          James Williams, a junior majoring in Chemistry at Princeton University, has been working through the Oxford University Clinical Research Unit in Ho Chi Minh City, Vietnam on a summer research project aimed at analyzing the role of pigs in transmitting Japanese Encephalitis Virus. He'll be returning to the states in two weeks, but before returning home James chose to guest-write this piece for TableTalk's A Blog With A View in an effort to depict the role of private research interests in the public health sector in Ho Chi Minh City.           

          Tucked away in a back corner of Ho Chi Minh City’s Centre for Tropical Disease, the Union Jack waves from the second floor of a nondescript building. The building looks no different from its neighbors, where HIV and malaria patients flood into the hallways on their makeshift hospital beds. But in fact, this building is different, housing labs and offices of the Wellcome Trust, a United Kingdom-based group of international biomedical researchers with associated branches in Bangkok, Kathmandu, Dar es Salaam, and Nairobi, among other places.

            Wellcome’s location in the Centre for Tropical Disease suggests something strange about the relationship between biomedical research and clinical practice, something that perhaps appears even more ominous in a developing country like Vietnam. One telling, albeit unofficial stat that was given to me: the average custodian at Oxford University earns more than the typical Vietnamese doctor. HCMC’s Hospital for Tropical Disease is a place of unders. Staff is underpaid, the hospital is undersupplied, disease goes underreported. Indeed, the only thing not in short supply seems to be the overwhelming number of patients in need of HTD’s services.

            So when we realize that Wellcome’s doctors are paid far more than their Vietnamese counterparts, we’re left with a sour taste in our mouths.

            At first glance, this means that money is being channeled from patient care to people whose principal job is not to heal, but rather to crank out paper after paper in European and American academic journals. And there’s some truth to this. Most work done at Wellcome won’t immediately improve patient outcomes, just as most research done in the States won’t result in the cure for cancer. In resource poor settings like Vietnam, then, it seems that money would be better spent investing in improving patient care or training more doctors. Right?

            But to think so idealistically is to ignore basic economic principles. Frivolous though investment in research may seem in 90% of cases, few would deny that the remaining 10% does justify that spending. Given how interdisciplinary it is, biomedicine is a field that requires the best and brightest individuals. And in order to attract the best and brightest, there needs to be some incentive. After all, the altruistic lure of helping your fellow man may not be enough, even when one throws promises of steaming bowls of Vietnamese pho into the mix.

            To understand how important this incentive is, it may be best to look at how medicine works when it isn’t there. Many people have criticized pharmaceutical companies for turning a blind eye to the millions of patients in developing countries who can’t afford their life-saving products. Between 1975 and 1999, fewer than 1% of newly designed therapeutic drugs were intended to treat tropical diseases. (Interestingly enough, a number of new medications were created to treat canine arthritis during this same time.) Research is time-intensive and expensive, and eventually there needs to be a reward for that investment, whether it comes from the wallets of sick patients or pet-owners.

          This is how the market will inevitably behave, unless we tweak the incentives. The simple truth is that the individuals capable of developing the cure for cancer could make loads of money as lawyers or investment bankers instead. But it isn’t easy curing cancer; research can take years to pay off, and there needs to be an immediate incentive to attract these individuals now. 

            So then back to Vietnam, where tropical disease is a bigger deal than canine arthritis and this disconnect between research and clinical practice becomes much more tragic. Are we justified in funding a research team of expat doctors while Vietnamese patients suffer next door? Is medicine a business or a basic human right? Is a bird in the hand worth two in the bush?

           You could argue these questions all day and not come up with a clear answer. Whatever your view, few would contest that the attention being given to tropical diseases is a good thing in any form. Ultimately, the fruitfulness of Wellcome’s research will depend on whether or not it can continue to attract the brightest researchers, and for now, there’s only one way to do that.

London Calling

The fatal shooting of Mark Duggan, a 29-year-old black resident of Tottenham in North London and father of four, ignited violence and riots which have persisted for the past week. However, reactionary riots over a shooting have spawned outbreaks of violence and disturbance across the entire country, mainly conducted by gangs of youth. While many wonder how the rioting has spun so far out of control, the correlation between these youths and teen unemployment might offer a possible explanation for the violence.

David Lammy, Tottenham Member of Parliament, explained on NPR's Morning Edition that Tottenham is a traditionally poor, inner city area, like Queens in New York, that makes up one of the most ethnically diverse districts in all of Europe. He explained that Duggan's death at the hands of the police sparked outrage and disturbance within the Tottenham community that has escalated into the widespread and senseless violence that the world has been witness to over the past several days. In the 1980s, profound racism within the police force directed towards black residents of Tottenham served as a catalyst for rioting and community violence, but, while acknowledging the parallel, Lammy explains that these riots aren't part of a greater war between a community and the police force, but instead senseless acts of violence between neighbors.

Since Saturday, mobs of young Londoners have carried the violence from Tottenham to Liverpool, Hackney, Manchester and Birmingham. Earlier on Morning Edition, Mike Hardy, director of the Institute of Community Cohesion at the University of Coventry, explained that a perception of growing disparities between those with and without wealth and opportunity has fueled the rioting throughout London. Jobless and alienated young people feel their communities are being targeted for cuts, and these youths on the margins of society feel like they're carrying the bulk of the burden imposed on society by the city's economic instability.

When I listened to this broadcast, another piece I'd recently heard on All Things Considered concerning high teen unemployment in the U.S. came to mind. Although the nation's unemployment rate declined to 9.1 percent in July, teen unemployment continues to rise, and currently we're in our third consecutive summer with teen unemployment rates above 20 percent - right now it's 25 percent. By allowing teen unemployment rates to soar, researchers worry that the country's creating a "lost generation"discouraged by bleak prospects and set back skill-wise in an already cutthroat job market.

Analysts have partially attributed the rioting to the government's austerity budget which will bring about billions in spending cuts. NPR reported that

the full impact of spending cuts has yet to be felt and the unemployment rate is stable although it highest among youth, especially in areas like Tottenham, Hackney and Croydon.

This last observation is reason for pause. Youths, the party most responsible for perpetuating the riots in London, are the ones hit the hardest by unemployment, especially in the areas that have been the hotspots of chaos over the past few weeks. Some argue that it's not that youths are unemployed, just unoccupied, and that we're just witnessing opportunistic criminality at the hands of young, unoccupied derelicts. Many believe that the creation of new jobs demands investment by the government, not the type of cutback in the budget we're seeing now. Former London mayor Ken Livingstone told the BBC that young Britons are facing "the bleakest future," and so we're seeing senselessness and violence permeating a climate of doubt and fear.

I fall into that lost generation of 16-19-year-old youths across the U.S. facing a future just as bleak as the one Livingstone depicted for young Britons. Before I came home for the summer after my first year of college, I had to make dozens of calls months in advance in order to eventually find just one restaurant in my local area in need of a server for the summer months. After several phone calls, one interview and several training periods where I raked in less than minimum wage, I finally got my summer job; however, it took a toll on my plucky, can-do attitude when I had originally set out with high hopes of joining the workforce, only to realize that virtually no one's hiring right now. I had to put in an inordinate amount of effort to pickup a part-time job in Bedford, a rural small town in southwest Virginia - I can only imagine how much more daunting my search would have been in a city like London, where you have a much more competitive labor market, or even in a city like Washington D.C. where the teen unemployment rate stood at 49 percent just this past June.

Before sociologists dismiss the London riots as a rampage of "opportunistic criminality," let's look at what the U.S. can take away from the turbulence across the pond: The unhappy, unemployed youths at the margins of society bearing the brunt of economic instability are the same youths rioting and pitching missiles at police officers.

It's not just about drawing parallels and connecting the dots, though. Here at home policy makers need to start taking precautions to remedy the sky-high teen unemployment rate, even if no one's anticipating outbreaks of violence or rioting on the scale we've seen in London. On a base level, NPR reported that

studies show the discouraged teenage job seeker can grow up to become a discouraged adult worker who is more likely to be underpaid and even unemployed. 

That's not the type of future I want to see forecasted for my generation, especially when we've seen the worst-case scenario for that type of discouragement and hopelessness over the course of the past week in London.