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.



Martin Young

Martin Young is an ENT surgeon living an idyllic life in Knysna. He is a firm believer that "the unexamined life is not worth living", writes for a hobby and is happy to speak truth to power www.drmartinyoung.com...

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