Improved Health Care for Underdeveloped Regions

Alex Soojung-Kim Pang — Tue, 23 Oct 2007 11:10:30 -0700

Description

Advances in technology and medicine, as well as the expiration of patents on medicine, promise to significantly improve health care in previously underserved regions.

The convergence of widespread health care research (and the ensuing knowledge) with the expiration of patents on medicines and medical devices, could make quality health care much more widely available in underdeveloped regions.

The developed world has been providing structured funding for 50+ years to address the unique health care challenges faced in poor regions (such as sanitation and nutrition). While these have contributed to significant progress in life expectancy within these regions, economic disincentives have prevented investment in research to address developing world diseases. Now many medical discoveries from the mid-20th century onward are coming into the public domain as patents expire and developing nations with drug industries (South Korea, Israel, India, and China) are waiting in the wings to manufacture generic versions of biologics (that is, follow-on biologics).

Furthermore, as information technology is likely to play a growing role in health care in developing nations, these nations are likely to benefit from the enormous number of health care applications now becoming freely available as 'open source'.

While these developments alone are unlikely to be sufficient, these, coupled with growing economies, improving educational systems and political priorities, could bring significant benefits to healthcare and life-expectancy in some of the poorest parts of the world."

This will be enabled by:

Upcoming expiration of the patents of some early biotech discoveries
Development of creative approaches to intellectual property that help to create domestic industries for generic drugs (such as India's policy of allowing process patents for drugs that are product patented elsewhere)

Early indicators include:

"Dr. Peter Lansbury's testing of more than 1,000 drugs on which the patent has expired for their treatment effects on Parkinson's Disease (Harvard Medical School)
India's increasing production of pharmaceuticals, making it the fourth largest producer worldwide, according to the World Health Organization"

What to watch:

"Foundation grants, together with the support of the UN and Western donor nations, enable development of inexpensive medicines for widespread illnesses.
Developing nations collaborate to create a complete drug development industry, from basic research through preclinical and clinical development to generic and new drug production.

Signals

Growth of Open-Access Scientific Publishing

Alex Soojung-Kim Pang — Tue, 23 Oct 2007 11:10:30 -0700

Description

Open access promises to replace the current scientific publishing establishment.

Open-access scientific publishing has been gaining ground in recent years alongside steep increases in the cost of scientific journals and a growing perception among scientists that business interests are impeding scientific discovery. For one journal subscription, scientists could pay nearly six figures per year In the next decade, the open-access model, whereby the producers of journal content pay, rather than the consumers. While this could simply result in traditional publishers adopting different business models, access to research papers will open, if slowly, and these papers will be free for all to read, distribute, reference, and copy as they see fit. The public will have the same access to the scientific and clinical literature as the "experts" potentially raising issues about "patient power".

This change in model reflects new power dynamics in the scientific publishing market: with the low cost of publishing, power has shifted back toward scientists and university libraries, many of whom have a strong interest in free and open access to science. These groups, along with certain scientific societies, have been aligning recently to start new journals and standardise archival methods. The US National Institutes of Health encourages its grantees to deposit their papers in PubMed Central, an online database for open-access papers, along with submitting them to commercial publishers. Starting in September 2005, the US National Institutes of Health will grant additional funds to researchers who plan to publish in pay-for-publication, open-access journals such as PLoS Biology. RCUK is considering similar measures under its full economic costing program. In the end, funding for open access will be provided by traditional money sources, including the government, universities, and even industry groups -or those who would have ultimately paid for subscriptions to non-open journals in the past. In the "big" science areas in life sciences and physics, the publishing costs are unlikely to be significant compared to the overall research budget and many open access journals offer preferential rates for papers from scientists working in developing countries. This shift in cost however is likely to affect "low overhead" research areas in developed countries, such as ecology and theoretical physics, where a few thousand pounds to publish a research paper will represent a significant proportion of the research budget.

Commercial journals will likely be forced to change their business models to survive the shift to open access, . but to survive as profitable businesses, these firms will probably need to offer additional value beyond that of their nonprofit competitors. Rather than charge for basic articles, they could differentiate themselves based on value-added services to scientists and readers with higher-quality presentation, editorials, and research synthesis. This is also likely to have a significant affect on learned societies in the UK, many of whom generate their income through their publishing arms and are already considering alternative models of income generation.

Open access still faces questions relating to its own appropriate business model. Critics charge that pay-to-publish open-access journals could compromise quality by accepting too many papers due to economic incentive. The Public Library of Science (PLoS) has sufficient momentum and funding to maintain its journals' quality, but this leaves open the question of whether other, more mid-level scientific journals will be able to survive with open-access business models. Further in the future, these concerns could be mitigated by 'bubble-up' forms of publishing driven by a radical rethinking of the current system of peer and editorial review.

This will be enabled by:

"Development of low marginal cost publishing technologies: the Internet, PDF, peer-to-peer file sharing
Technological and social innovations in paper publishing
New methodologies of peer review based upon ratings systems and 'bubble-up' technologies"

Early indicators include:

"Free archiving, since 1991, of work by physicists online at arxive.org
Dropping in 2004 by the International Society for Computational Biology of its affiliation with a non-open press in favor of PLoS Computational Biology, an open-access journal
Vote by the faculties of Stanford and the University of California in early 2004 to boycott Elsevier journals, even though more than 100 University of California faculty serve as senior editors and more than 1000 serve on editorial boards of Elsevier journals
En masse resignation of several of Elsevier's editorial boards to form new open-access journals, many of which are directly supported by the learned societies in their respective fields
Role played by telescope logs published on the Internet in discovery of the 10th planet"

What to watch:

Downloading of articles from the Public Library of Science's and BMC's online journals increases exponentially.