A review of Pharmacy on a Bicycle: Innovative Solutions for Global Health and Poverty, by Eric C. Bing and Marc J. Epstein
@@@@ (4 out of 5)
Despite the widespread conviction that the state of the world is deplorable and getting worse by the day, the human race has made measurable, even dramatic progress in some important ways. The collective state of our health is the most telling example. In part because of the eradication of smallpox, the near elimination of polio, and the significant recent progress on HIV/AIDS, humanity in general is living longer and healthier lives. Average life expectancy at birth in India around 1950 was 38 years; today it is 65. In China, it was 41; today it is 77. Over the same period, average life expectancy in the United States has risen from 65 to approximately 80. Numbers can be misleading, but these tell a compelling story.
Building on this amazing success story, major institutions — the United Nations, the U.S. Government, and the Bill and Melinda Gates Foundation, for example — have invested billions of dollars in recent years, targeting specific diseases, promoting the use of vaccines, and building public health infrastructure in developing nations. All these admirable efforts promise to continue the favorable trend in healthcare that has unfolded over the last half-century.
However, there is a hidden dimension in this picture. As Eric Bing and Marc Epstein explain in Pharmacy on a Bicycle, billions of poor people living in rural areas all too frequently fail to gain the benefit of these advances in healthcare. It’s fashionable to look on the world today from the perspective of the cities, but in spite of the massive migration of the last several decades, nearly half (49%) of the world’s population still resides in rural areas. Great numbers of these people live far from transportation hubs, often hours or even days of walking from the nearest road. It’s to these billions of people, nearly all of them desperately poor by American or European standards, that Bing and Epstein turn their attention in their illuminating little book.
Pharmacy on a Bicycle rests on a single, fundamental premise: “Most poor outcomes [in healthcare] are caused not by lack of effective medicines or medical know-how. The ability to prevent and treat many of these diseases inexpensively has been available for a very long time. But getting the right remedies to the right people in the locations where they are needed, in a way they will use them, and at a cost they can afford is continually a challenge. This is not a scientific problem. It’s a business challenge.”
Bing and Epstein argue that humankind has never before been in such a good position to meet this challenge. The costs of many widely-used drugs have fallen dramatically, and scientists have greatly simplified the treatment of many diseases by combining multiple drugs into single capsules or tablets. Extremely cheap diagnostic techniques that provide nearly instant assessments are now available. Through telemedicine, a single well-trained physician can now offer her or his expertise to much larger numbers of patients. The widespread use of clinical checklists and the application of franchising to the healthcare industry have both improved access and lowered costs. And new business models, successfully piloted in many countries, using bicycles, motorcycles, and trained village-level representatives, make it possible for healthcare agencies and for-profit companies to overcome the “last mile problem” that has traditionally limited most of the benefits of the market economy to population centers. “We are now at a tipping point to make lasting global health impacts,” the authors write.
One of the most promising recent developments is the now near-universal access to cell phones; by next year, the number of mobile phones is expected to be greater than the world’s population. “Mobile phones are now being used for patient education and awareness, treatment compliance, health care worker training, data collection, disease and epidemic outbreak tracking, and diagnostic and treatment support.”
Pharmacy on a Bicycle is intended to spark much wider adaptation of these advances by making them more widely known. The book presents a seven-point implementation model called IMPACTS, which encompasses innovation and entrepreneurship, maximizing efficiency and effectiveness, coordinating with partners, accountability, creating demand, task shifting (e.g., empowering nurses to take on some doctors’ responsibilities), and scaling. The book includes an abundance of excellent examples that bring these deadly-sounding prescriptions to life.
Eric Bing is an M.D. who also possesses a Ph.D. in epidemiology and an MBA. He’s the director of global health at the George W. Bush Institute at Southern Methodist University. His co-author, Marc Epstein, is an eminent and much-published professor of management at Rice University in Houston whose previous teaching posts were at the Harvard and Stanford business schools and INSEAD (European Institute of Business Administration).
My top 20 nonfiction picks
For nearly three-and-a-half years now, I’ve been posting book reviews in this blog, typically twice a week. For my own benefit as well as yours, I like to look back every so often at the books I’ve read and think about what I’ve learned from them. What follows below is a list of the 20 nonfiction books (out of more than 100 I read) that have added the most to my understanding of the world. They’re arranged in no particular order: I can’t imagine trying to pick the best of this lot!
Going Clear: Scientology, Hollywood, and the Prison of Belief, by Lawrence Wright
The definitive study of the belief system known as Scientology, with an emphasis on its human rights violations and the Hollywood celebrities it has gathered into its “prison of belief.”
Mary’s Mosaic: The CIA Conspiracy to Murder John F. Kennedy, Mary Pinchot Meyer, and Their Vision for World Peace, by Peter Janney
Revelations galore from newly unearthed evidence about the assassination of John F. Kennedy and his last years in the White House.
The Swerve: How the World Became Modern, by Stephen Greenblatt
The seminal role of a long-forgotten ancient Greek poet and philosopher on the thinking of the geniuses who shaped the Renaissance and on the course of history that followed.
The Revenge of Geography: What the Map Tells Us About Coming Conflicts and the Battle Against Fate, by Robert D. Kaplan
Recent history and current events through the distorting lens of geopolitics, which views Planet Earth, and the machinations and foibles of earthly leaders, from a very different perspective than is found in most history books.
Freedom’s Forge: How American Business Produced Victory in World War II, by Arthur Herman
The astonishing story of America’s rearmament in World War II, with a focus on the two larger-than-life personalities who made it happen through sheer force of will: William Knudsen and Henry J. Kaiser.
Double Cross: The True Story of the D-Day Spies, by Ben McIntyre
The stranger-than-fiction story of the British double agents whose brilliant work in Europe played a pivotal role in the success of the Normandy Invasion.
The Power of Unreasonable People: How Social Entrepreneurs Create Markets That Change the World, by John Elkington and Pamela Hartigan
A comprehensive and well-informed view of the world of social enterprise and the extraordinary individuals who stand out in a field that attracts brilliant and inspired people by the carload.
The Self-Made Myth, and the Truth About How Government Helps Individuals and Businesses Succeed, by Brian Miller and Mike Lapham
An in-depth refutation of the myth of rugged individualism, lionized by Ayn Rand’s novels and enshrined in conservative and libertarian ideology for four decades.
The New Jim Crow: Mass Incarceration in the Age of Colorblindness, by Michelle Alexander
How the War on Drugs, and the institutionalized racism that undergirds it, has weakened American society and fostered a new underclass dominated by young men of color.
Behind the Beautiful Forevers: Life, Death, and Hope in a Mumbai Undercity, by Katherine Boo
A first-hand account of three years in a slum neighborhood in one of the biggest cities in the world, focusing on the hopes and challenges of two local families.
Infinite Vision: How Aravind Became the World’s Greatest Business Case for Compassion, by Pavithra Mehta and Suchitra Shenoy
A beautifully-written account of the history of a nonprofit South Indian eye hospital that has pioneered a revolutionary approach to eye-care which has brought relief to millions of poor people worldwide.
Steve Jobs, by Walter Isaacson
An unvarnished biography of the design and marketing genius who built Apple and gained a place in business history alongside Thomas Edison, Henry Ford, and Sam Walton.
Top Secret America: The Rise of the New American Security State, by Dana Priest and William M. Arkin
The troubling story of the institutionalization of a new military-intelligence complex triggered by 9/11 and accelerated by the wars in Iraq and Afghanistan.
In the Garden of Beasts: Love, Terror, and an American Family in Hitler’s Berlin, by Erik Larson
The long-overlooked story of FDR’s ambassador to Nazi Germany and his frustrated efforts to turn U.S. policy against Hitler in the face of horrific violence against Jews in Germany and anti-Semitism in the State Department.
The Emperor of All Maladies: A History of Cancer, by Siddhartha Mukherjee
An oncologist’s critical study of the diseases lumped together under the label of cancer and of humanity’s halting efforts to arrest and cure them.
Cleopatra: A Life, by Stacy Schiff
A fresh new take on one of history’s most powerful and fascinating women, long caricatured in popular fiction and history books alike.
The Devil’s Casino: Friendship, Betrayal, and the High Stakes Games Played Inside Lehman Brothers, by Vicky Ward
An illuminating tale of the people who set off the Great Recession, bringing to light the greed, self-delusion, and miscalculation that came so close to collapsing the world economy in 2008.
Cyber War: The Next Threat to National Security and What to Do About It, by Richard. A. Clarke and Robert K. Knake
A profoundly troubling look at the rapid rise of cyber warfare and the existential threat it poses to American civilization, written by the top counterterrorism official in both the Clinton and Bush Administrations.
The Immortal Life of Henrietta Lacks, by Rebecca Skloot
Based on ten years of dogged research, a science journalist’s deeply moving account of the African-American woman whose cancerous cells seeded six decades of medical discoveries.
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Tagged as Aravind, Ayn Rand, Ben McIntyre, Bill Knudsen, cancer, CIA, cia conspiracy, Cleopatra, cyber warfare, D-Day, Dana Priest, Erik Larson, eye care, geopolitics, Henrietta Lacks, Henry J. Kaiser, hollywood celebrities, John Elkington, John F. Kennedy, Katherine Boo, Lawrence Wright, Lehman Brothers, libertarian ideology, mary pinchot meyer, mass incarceration, michelle alexander, military-intelligence complex, Mumbai, Nazi Germany, Pamela Hartigan, poverty, racism, Rebecca Skloot, Renaissance, Richard A. Clarke, Robert D. Kaplan, rugged individualism, scientology, Siddhartha Mukherjee, Stacy Schiff, Stephen Greenblatt, Steve Jobs, The Swerve, Vicky Ward, Walter Isaacson, War on Drugs, William S. Knudsen, World War II