Pharmaceuticals for Developing Countries Conference Proceedings (1979) / Chapter Skim
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HISTORICAL PERSPECTIVE
HISTORICAL PERSPECTIVE
Pages 9-28
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From page 9... ...
For the fourth point was the announcement of a program in which the highly valued technology of the United States would be made available for the development of the badly impoverished nations of the world. Biomedical or health technology, if you will, was just coming into flower at that time.
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From page 10... ...
On the contrary, the influence has been a continuing affair and includes far greater consequences, both technologic and social, than are generally appreciated. Everyone knows the drugs transformed the disease pattern of the United States and ultimately that of the rest of the industrialized world.
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From page 11... ...
For, if its output is not having too much effect on the United States people, it might not hold forth much promise for those in developing countries. Consequently, while considering the role of the United States industry in the developing countries, this issue of the health impact of the personal service system must be resolved.
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From page 12... ...
From 1900 to the mid-1930s, the United States death rate showed a slow but steady fall. I-have presented evidence elsewhere that very little of the fall could be attributed to drugs or other therapies of the personal physician system.
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From page 13... ...
There was no new vaccine program -- no major change in lifestyle. A new drug was introduced that was applicable to the problems of large numbers of people, young and old, and was applied only through the personal physician system.
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From page 14... ...
RESPIRATORY TUBERCULOSIS, MEAN ANNUAL DEATH RATE IN ENGLAND AND WALES a/ E i X H |
From page 15... ...
This interpretation of McKeown's viewpoint gets reinforced by his stated belief that even after 1935 the available chemotherapy is less effective than that of other influences against a whole spectrum of bacterial diseases. His concept thus gets projected into the future and is used extensively in support of the alternative health strategies "movement." In Figure 3 may be seen the same tuberculosis death rates as in Figure 1.
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From page 16... ...
It is not always realized that malaria, cholera, yellow fever, and smallpox were all important diseases in the northeastern United States at one time -- hookworm was well known in parts of the rural South. To all intents and purposes, these have disappeared as problems.
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From page 17... ...
A graph of the infant mortality in New York City from 1900 to 1930 may be seen in Figure 4. At the turn of the century (shown on the left)
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From page 18... ...
important particulars resemble those of a developing country. This was done as part of a large-scale project in the middle of the Navajo Reservation in Arizona and was financed in part by the tribe itself.V The people lived far from each other in dirt-floored, windowless, waterless log huts and maintained a very high birth rate -- 47 as compared with the general United States rate of around 14 today.
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From page 19... ...
Our medical technology has relatively little to offer infants who are located in a virtually unprotected home environment. The lessons thus far can be summed up: first the drugs invented for United States society have had demonstrable and major effects on its level of health; second a disease pattern of great importance in developing societies -- the pneumonia-diarrhea complex of infants -- largely disappeared from our society without the use of today's technology, but in a setting of widespread economic uplift; third attempts to substitute the drugs effective in United States society for a complete lack of sanitary barriers in the home are apt to have quite limited value in developing countries.
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From page 20... ...
The principal United States contributions to this development had to do with the invention of highly imaginative manufacturing methods, notably deep tank production of penicillin, and the creation of a system of university-based clinical penicillin investigators financed by government contracts. This was done through the National Research Council of the National Academy of Sciences, which formed this government-supported system largely run by nongovernmental scientists.
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From page 21... ...
One answer is that the United States entered World War II as the decade began. In short, it was wartime.
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From page 22... ...
As noted earlier, using this system the actual inventions or discoveries of research and development in the pharmaceutical industry have almost exclusively been therapies (or contraceptives) that fit the United States disease pattern and require some form of personal service system for their administration.
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From page 23... ...
The question is no longer whether a treatment for X disease can be developed; it becomes changed to: can one be developed that can be purchased and delivered for one United States dollar per capita, per year, when the total budget for all health services is only two dollars per person, per year? Neither arm of our present system has such capability, so that the plea that they do more becomes meaningless.
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From page 24... ...
Whatever it was that was responsible for that difference between 35 and about 150 tuberculosis deaths per 100,000 people each year, obviously was no constraint on the effectiveness of the technology. There is reason to believe the marked pre-treatment differential reflected the living conditions of the black poor in New York City in the 1940s.
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From page 25... ...
And if success comes, there will be many more a day than there is now in which one can say with some satisfaction, "Sometimes the poor get lucky." FIGURE 5. TUBERCULOSIS MORTALITY FOR BLACKS AND WHITES, NEW YORK CITY, 1905-1955 O O O O O flC LU QUJ tr x UJ O IOOO 800 600 4OO 200 100 80 60 40 20 10 8 6 41947 StortofDrugEro 5-YEAR AVERAGES INDIVIDUAL ANNUAL RATES i i i i i i i i i t i i 05 10 15 20 25 30 35 4O 45 50 55 60 65 70 YEARS 25
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From page 27... ...
Paper presented at the annual meeting of the Institute of Medicine, National Academy of Sciences, Washington, DC, October 1976; and Role of Medicine: dream, mirage, or nemesis. London, Nuffield Provincial Hospitals Trust, 1976 4.
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