Factfulness: Ten Reasons We're Wrong About the World – and Why Things Are Better Than You Think

Medicine Is Not the Single Solution

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Medical professionals can become very single-minded about medicine, or
even a particular kind of medicine.
In the 1950s, a Danish public health doctor, Halfdan Mahler, suggested to
the World Health Organization a way to eradicate tuberculosis. His project
sent small buses with X-ray machines trundling around villages in India. It
was a simple idea: eradicate one disease, and it’s gone. The plan was to X-ray
the whole population, find those with TB, and treat them. But it failed
because the people got angry. They all had tons of urgent health problems,
and finally here was a bus with nurses and doctors. But instead of fixing a
broken bone, or giving fluids for diarrhea, or helping a woman in childbirth,
they wanted to X-ray everyone for a disease they had never heard of.
Out of the failure of this attempt to eradicate one single disease came the
insight that, instead of fighting this disease or that disease, it is wiser to
provide and gradually improve primary health care for all.
In another part of the medical world, the profits of Big Pharma companies
have been dropping. Most of them are fixated on developing a new,
revolutionary, life-prolonging medicine. I try to persuade them that the next
big boost in world life expectancy (and their profits) will probably come not
from a pharmacological breakthrough but from a business model
breakthrough. Big Pharma is currently failing to reach huge markets in
countries on Levels 2 and 3, where hundreds of millions of people, like the
diabetes patient we met in Kerala, need drugs that have already been
discovered, but at more reasonable prices. If the pharmaceutical companies
were better at adjusting their prices for different countries and
different customers, they could make their next fortune with what they
already have.
Experts in maternal mortality who understand the point about hammers and
nails can see that the most valuable intervention for saving the lives of the
poorest mothers is not training more local nurses to perform C-sections, or
better treatment of severe bleeding or infections, but the availability of
transport to the local hospital. The hospitals were of limited use if women
could not reach them: if there were no ambulances, or no roads for the
ambulances to travel on. Similarly, educators know that it is often the
availability of electricity rather than more textbooks or even more teachers in
the classroom that has the most impact on learning, as students can do their
homework after sunset.