Medical research is thriving. Every day new discoveries are being made for “incurable” conditions and we are constantly learning of better, faster, and more efficient ways to deliver care. Despite this, those who live in rural, inner-city, or low socioeconomic areas are disproportionally affected by “common” conditions such as infant mortality, COPD, ischemic heart disease, stroke, diabetes, and hepatitis C. So why is it that these individual’s health conditions are not improving with these findings? While there is no simple answer, one contributing factor is the unfortunate truth that these medical advancements do not find their way to these increasingly isolated areas.
Odds are, if you live in a wealthy metropolitan area, or you reside next to a major academic medical center, you have access to some of the best healthcare in the world. It is a shame that the number of people who actually live in these areas is incredibly small. A large amount of Americans live in rural, inner city, or low socioeconomic communities that have significant barriers (such as cost and location) to any healthcare, let alone the latest medical advancements. These barriers are compounded by other factors such as ethnicity, income level, insurance coverage, immigration status, and other social determinants.
However, cost and location are not the only reasons for this disparity. Every year, millions of dollars pour out from the National Institutes of Health (NIH) with the hope of making new discoveries. Once one of these findings is made public, the researchers rejoice and move on to the next project, hoping to make another advancement. These initial findings may be inefficient, requiring large amounts of money or sophisticated technology found only in academic medical centers. In the 21st century, the responsibility is on researchers, physicians, legislative bodies, and the communities to ensure that these discoveries are made accessible to the people who could benefit most from these findings.
One recent and still evolving example of this is the medications currently used to treat hepatitis C. Hepatitis C is one of the heart-warming stories of the 21st century, going from an unknown viral illness in 1989 to over 90% cure rate in 2013. The scientific advancements for hepatitis C have been nothing short of a miracle for those affected with the illness. However, the dark underside of this story is the astronomical costs that come with hepatitis C treatment. Estimates vary, but treatment costs for hepatitis C can range from $25k to $100k with over 95% being eventually cured. In addition to this, treatment courses run from 6–24 weeks of continuous oral medications. With heroin use continuing to ravage much of America’s rural and inner-city communities, hepatitis C is becoming a major concern, one that many will struggle with despite there being a reliable cure.
Related to the topic of money is the source of funding for medical research. Much of the medical research in this country comes from the NIH who receives their money from Congress. On average, the individuals in Congress are affluent persons living in areas around major academic hospitals with access to these advancements. From their point of view, they have access to whatever is available for treatment and do not have to concern themselves too much with the cost. How much have we heard about John McCain’s concerns of finances when it comes to his battle with cancer? Representative McCain has the luxury of being able to both afford and access the absolute best care in the world. Members of Congress may be so detached that they do not understand how the majority of Americans will not see these same medical advancements for potentially 20–40 years, causing them to ignore this disparity.
With all this in mind, we have to ask: what can be done? The answer is one that is complex and will require large changes. To begin, we have to start offering more incentives for physicians to practice in disadvantaged areas. It does not matter how advanced medicine becomes if there are no providers to deliver treatment. Supplementing this, we must begin to fund communities to improve their infrastructure and update their medical facilities to support the latest advancements. Once the providers and the facilities are in place, we will begin to see some of the advancements trickling into disadvantaged areas.
The next change is a cultural one that will take time and require buy-in. We must change the way investigators view disease and the goals of research. There needs to be a radical shift in the mindset of academics that the results of research need to be not only affordable but accessible. A drug that cures hepatitis C but costs $1000 per pill will not be able to help the vast majority of Americans. The goal of research should not just be to create an advancement, but to ensure that the advancement is attainable. One way to promote this is preferentially fund researchers who have a structured plan on how they will ensure their research findings are affordable and accessible. Supplementing this, well-respected academic journals could provide preference to publish research that has addressed the idea of cost or delivery.
Currently, we are seeing a horrible disparity in who is receiving care and the level of care they are receiving. Depending on where you live and how much you make, you may not receive the most recent medical treatment, which is contrary to the American dream. Efforts need to be made to ensure that all Americans have access to the medical advancements they are funding with their tax dollars. We in the medical community must not sit back and watch as members of this nation suffer simply due to the place they were born.
Zachary Smothers is a second-year medical student at Duke University School of Medicine.
