Martin Young
Martin Young

How money is more important than lives in healthcare technology

I saw via Twitter an interesting link on Reuters here about how students have developed a smartphone application with a microscope attachment to diagnose malaria. The article shows a picture of a child at risk somewhere in Africa.

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.”

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

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, 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 10 years — ubiquitous super-bugs and no means of treating them.

Primary care practice is just not a money-maker, whereas specialist practice is. Never mind that general practitioners are needed as much if not more. It is not a good career investment, and that is why so many doctors like me left to specialise.

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.

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 intention of 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? I suspect it will cost as much as or more than the smartphone 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 in 2010 killed more than 850 000 people, 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 continue to climb.

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    • Martin Warburg

      If there isn’t something in it for the guy who thought of it in the first place he will lose interest – and probably never bother to think of another great idea. Surely there is nothing wrong with earning something for your ideas – and the better the idea, the more investors will be interested and the more you will earn. That is a win-win – and a great thing!

      Without the profit motive the world would have remained impoverished and life expectancy would be a fraction of today’s levels because free lunches don’t exist in the real world.

      You better hope that mealie mouthed do-gooders never take over – or we could all die from self righteous indignation – if not incurable diseases that no one bothered to find cures for.

    • skerminkel

      Ask your question the other way around: would the company have bothered developing the device if there was not profit to be made? Same with antibiotics. Would they even have existed if there was not profit in developing them?

      You could well argue that companies should take a longer term view of the industry, but in the end they have to employ the best employees they can find to come up with the best new technology/medication/whatever.
      You can argue that these employees should not only consider salary and perks when taking a job, but then their families will carry the can to get a dose of malaria treatment to some obscure little town in Africa.

      It is the duty of governments to balance the cost and reward of medical care. If they want the treatment cheaper, encourage competition between manufacturers and suppliers.

      I would love to read Ivo Vegter’s take on this!

    • Rory Short

      Our culture has reached a point where money is seen as the primary motivator of human beings. This is not naturally the case for most if not all people that is, unless you have been conditioned to believe it. Unfortunately for humanity those crippled people, for whom money has become the primary motivator, they use their money to try to ensure that the same sickness infects as many other people as possible. I have notice on broadcast business programs for example that there is never any mention of offering a useful product or service being the primary purpose of the business with the money being a natural by-product. No, one is in business purely to make money, and that is it, nothing else.

    • Walter

      Why is profit such a dirty word to you? And what on earth do you think these people do with their profits? Stuff in under a mattress and count it every evening before going to bed?

      As Adam Smith pointed out (maybe the basic understanding of how profit works in the world has escaped you), It is not from the benevolence of the butcher, the brewer, or the baker that we expect our dinner, but from their regard to their own interest.

      Profits are divided up into taxable stated profit, business expansion, continued research, investment in stocks and firms, and cash in bank. All of which benefits man as it either employs people, funds more products and discoveries, or lent to people to purchase homes or businesses etc.

      It is sad that there are actual grown-ups in this world who cannot see any benefit to profit. Even those who spend their lives helping others do so for personal reasons other than the pure unselfishness of it. It is where they find fulfillment, but it rarely does anything near as good as what ‘the profit’ does.

    • Storm Ferguson

      Well written Sir. Sadly your view illustrates the sickness in our world society today and worse in our individual stance towards each other.

    • ian shaw

      Several specialists recognized the moneymaking value of relatively cheap ultrasonic scanners. For example, urologists and gynecologists nowadays require their use for all new patients, whereas in the past these devices were used only when needed.

    • nguni

      @ ian shaw
      that’s not the whole story on ultrasound. There IS a big lobby out there wanting to keep the technique pricey. So although they are getting smaller and lighter they have stopped getting cheaper. Pity really, it’s such a useful tool.

    • Maria

      Despite several people having pointed out, with telling indignation, that profit is the primary motivator to most people – yes, Adam Smith already knew this – one might expect that when it comes to human health, goodwill and a kind of benevolence on the part of people who venture into this field might prevail. But no – except for precious few doctors (who usually practice at state hospitals by choice) – as Rory and Storm recognize, the majority of humanity have been infected by this humanity-destroying virus of “profit at all costs”. It is easy to pick out people who have not succumbed to this; they stand out from the rest because they have not been reified by that most alienating commodity of all: money.

    • Rory Short

      @Walter I too believe in economic freedom. It is the nature of people to want to have an impact on the world and that should be encouraged rather than hampered. There is one caveat however and that is that the impact should be generally beneficial. How do we assess impact in that regard? it is definitely first and foremost a personal matter but there is also societal consensus on some things. Drug dealing for example is generally agreed to be destructive and therefore illegal. However the manufacture of armaments is quite legal and yet I think this activity is destructive and should be banned. It is very difficult for us to exercise our individual moral preferences however because our money, as of now, has no moral colour whatsoever. When presented with a Rand it is completely impossible to tell from what activity it was generated, whether constructive or destructive, making it very difficult to make a moral judgement on whether to accept it or not.

    • Zach de Beer

      I am a harsh critic of healthcare systems and all associated entities. The simply truth is be cannot get new drugs or devices iv money is not invested. The cost of develpoing this malaria app is tiny compared to developing the app itself. Gabillions versus a few million. So in the “Idea” world the developers must donate the device and then go look fort more inverters that would laugh at them and the game stops.

      We owe our lived to the gabillions that have been invested in pharmacy, devices and so on.

      Let’s then go back to traditional medicine that does not work and it is cheap. No scanners required, no phones, brain scanners, hart lunch machine, antibiotics, psychiatric medicine and back drawing blood.

      It is like expecting a car fir free because you are poor.

      There things can only be done with highly qualified skilled people and the don’t come cheap. If there is no money in medicine they will become stockbrokers.

    • Martin Young

      Walter

      I’ll tell you when it will make a big difference- that is when the profit motive in medicine impacts us both directly. If like me you are in your fifties or younger, there is an above average chance that both of us will need joint replacements at some stage – around the age of seventy.

      The risks of sepsis during joint replacement surgery are substantial, and antibiotics are a crucial aspect of both preventing and treating this situation. Because it is no longer profitable to develop new antibiotics, the likelihood of us having useful ones in twenty years time is dismal. Bacteria are not holding back and being ‘nice’ or ‘ethical’ or ‘fair’ in the meantime. Resistance, bad already, will be universal in 20 years

      Not to mention the other areas in which modern medical care is dependent on good antibiotics, especially in an aging population. As far as I know there are NO new antibiotics being developed. None!

      So all those my age and younger are going to be the primary victims of the profit motive in medicine staying away from essential developments that could protect us.

      That is a very sobering prospect in my view.

    • Walter

      From time of discovering a new drug, to submitting it to the FDA for approval, to having it tested, tried, checked, double checked and then finally having it peer reviewed and then placed into the mouth of the first patient, the cost is approximately $1 billion. GOVERNMENTS have made this so expensive, NOT private industry. Who the hell can go through all that for free? It makes perfect sense that if your initial outlay is so risky, and the expected returns so precarious that it would take financiers an awful lot of comfort before they would consider risking this sort of money. It is NOT the profit factor that makes these industries shy away from certain drugs, but the high cost of doing business, even before you CAN actually do any business, that makes it the high risk and costly industry it is.

      But while we’re at it, what is the percentage of taxable profit on any given drug? Or do you honestly believe everyone should be working for free in this industry? And why should people have to suffer in order to meet your general approval by working for mahala? As if this noble act is payment enough.

      The average profit margin is around 12.2%. Most of that gets re-invested, taxed and used to fund the next project. What remains is in the low single figures. By removing this (even as the mild incentive it is) what difference to the overall cost will you be saving?

      Personally, I’d rather take drugs from PROFITABLE businesses than those claiming virtuous poverty.

    • Momma Cyndi

      In R+D, you will often have 50 ‘failures’ before finding the right option. That means time and money. You also have a surprisingly short period (and it gets shorter and shorter) to recoup the money lost to those ‘failures’ before some smarty pants comes along and deconstructs your ‘success’ to clone it or pirate it for is own benefit. It becomes (unfortunately) a rush to make hay whilst the sun shines.

      Should the creator of this wonderful little app have the assurance that he would be able to make a few cents off each application for the rest of his life, he would probably be more than happy with the deal. Reality is that he will be completely cut off from all royalties on it within a few months (a year at most). As much as I would love to see this going out for free, the guy has to eat and pay rent – just like you doctors have to. That is why you went through all those years of university and don’t live in a cardboard box next to the highway.

    • Uffa

      The whole trouble is that medicine-ie. drs, the pharmaceutical and the medical instrument industries are oriented toward the relief of disease ( not too much though as it is self destructive) and do not see the wood for the trees. We are in constant contact with bacteria for instance and depend on them for life itself and they only become a threat when the human organism loses its vitality and homeostatic forces.If all the billions discussed were put into improving the dietary and environmental lot of humanity we would not need all those ‘trees’. We need to focus on Health not Disease.