Merck and research ethics ... and community impact

Dear Colleagues

A recent article in the New York Tines talks about something that many of us have suspected for years:

April 16, 2008
Merck Wrote Drug Studies for Doctors
By STEPHANIE SAUL
The drug maker Merck drafted dozens of research studies for a best-selling drug, then lined up prestigious doctors to put their names on the reports before publication, according to an article to be published Wednesday in a leading medical journal.

The problem with this is that research and (peer reviewed) publication are at the center of the health industry's modus operandi and how critical information is shared both within the research community and to the wider public.

I worked for a consulting unit of a well known accounting firm some years ago (more than 10) and was appalled to find out how many "studies" the firm had made about health and the impact of tobacco products. The correlation between the research and the results was dwarfed by the correlation between the fees from the tobacco companies and the results. Other work seemed to be more about the fee flow than the value of the work to society. I was appalled ... people knew it ... and I did not last too long as a member of the staff.

The importance of profit and financial returns has taken over modern society ... and we are all now at risk. The house of cards is tumbling down ... which is a pity. In the past fifty years science has progressed in an impressive manner, but it has been very badly used to improve the global society ... me and my wealth has become much more important that we and society's wealth.

Tr-Ac-Net wants to see community impact as the driver of decision making ... especially as it relates to the allocation of resources for development. With this approach to performance metrics it will be possible to get young energy and innovation to work on important issues and not have to take a vow of poverty to put their time into these important things.

And then it would be great to see Merck paying its researchers based on the amount of community good their work makes possible.

Sincerely

Peter Burgess

Public health infrastructure

Dear Colleagues

Public health infrastructure maybe better than it was a century ago ... but in most or the Global South, the state of the public health infrastructure is appalling.

Why is this? Health has been a priority for international support from donors for decades ... but has it really been able to do much good.

It is possible to argued that health is the perfect scam. Everyone is easily convinced that disbursing money for health is a good thing. In this situation fund raising is relatively easy, and programs get approved.

But what exactly is the money going to be used for? In my own personal experience as an acting aid coordinator for an African country, 16 different countries were offering bilateral assistance for the health sector. The problem was that every single one wanted to use the money available to study the sector, and not one was willing to help fund what other studies (and very good studies at that) showed was most needed ... help with buying drugs, help with increasing operating expenditure disbursements, help with training more nurses, etc. In order to get a small amount of the things we needed, we had to have studies that nobody needed and did nothing but consume available funds.

My impression is that the problem that I describe ... which was 15 years ago ... is as bad as ever.

Another issue is that the general expectation of support from the health budget of government is unrealistic given the terrible state of most countries' public finances. Donors have helped in some cases with program funding for health, for example, for AIDS, for immunization, for bednets, etc. And while this has helped to get some of the needed items into the country, the underlying failed health infrastructure remains a problem.

The top down planning favored by WHO, the World Bank and others in the international donor community encourages the program approach, and makes coherent health activities at the community level a distant dream.

Tr-Ac-Net is committed to the idea that development performance will be improved substantially as soon as performance is looked at from a community perspective. From this perspective much of the international community's support seems to be badly allocated and essentially almost useless. This is a serious observation ... over and over again, I have been asked why is it that nobody will help with what we need, but we can get all sorts of resources for things that we don't need.

One of the areas that is needed ... improved public health infrastructure ... meaning funds for staff and for medication that is needed to treat people with illness ... and funds to help make communities healthier through better prevention.

One step at a time ... one community at a time will work.

Sincerely

Peter Burgess

Health and development

Dear Colleagues

The Tr-Ac-Net perspective is that health is an important component of development ... but the performance of the international relief and development sector over the past several decades has been poor ... and the pre-occupation with health is one of the reasons for the poor socio-economic results.

Health is a VERY important part of development ... but human health without economic health in the society is not an adequate outcome.

One of the most widely used one liners about health is "Malaria kills 3,000 children every day in Africa". Less widely used is the statistic that 30,000 children die every day in Africa from a variety of causes, most of which are preventable ... and poverty, hunger, polluted water are some of the preventable causes.

As work is done to improve the health situation for the world's population, it is imperative that the causes of ill health are included in the analysis so that decisions are made that will result in sustainable progress. The crisis of malaria is, in part, caused by malaria control strategies that have failed to address the problem of perpetual reinfection.

There are many questions, and the medical profession knows most of the answers:

• How does health impact poverty? How does poverty impact health?
• What role does polluted water have in causing disease? What role poor sanitation?
• Is hunger a cause of ill-health? Is ill-health a cause of hunger?
• What role shortages of medical staff?
• What role shortage of medicines and medical supplies
• Is the health sector funding too much ... or too little ... or wrongly applied?

The challenge is to get these questions answered and for actions to take place to correct the situation. This is only partly a health sector question ... in large part it is health in conjuction with many other parts of the economy and of society.

The potential for success is available ... but the system needs to be improved in order to realise success with the available resources.

Sincerely

Peter Burgess
The Tr-Ac-Net Organization

Incredible science ... terrible economics

Dear Colleagues

The primary impression that Tr-Ac-Net has about health is that the science is incredible, but that the economics are terrible. This is a systemic problem that needs to be addressed, yet those in control either have no interest in solving the problem, or are incapable of solving the problem. Neither is a good situation.

The good news is that because the underlying science has progressed so well over the past several decades, and there is a huge pool of incredible talent in the health sector ... a solution to the economic crisis can be fashioned so that there is an almost universal win-win-win.

Tr-Ac-Net wants to contribute to the dialog that we see as an essential part of almost any systemic change, and especially change where some of those in control have huge economic incentives to maintain the status quo.

Sincerely

Peter Burgess
The Tr-Ac-Net Organization