The Process — Mountains Beyond Mountains

Solving the problem of MDR-TB is circuitous at heart. In order to address the growing costs of treating drug-resistent TB, there must be measures taken to lower costs of second-line drugs. In theory, this can be done by finding generic drug manufacturers and asking these parties to produce cheaper medicines. But in practice, drug manufacturers are only willing to produce cheaper generics if there is the demand to justify their investment. In order to create this demand, PIH hoped to collaborate with WHO to modify the processes used to treat tuberculosis (see previous post). From the perspective of WHO, changing treatment processes for MDR-TB are only economically feasible if the costs incurred by second-line drugs is significantly reduced. And then return to “there must be measures taken to lower the costs of second-line drugs.”

I’ve come to realize that this process is something we’re all familiar with. We start a project hoping for the best out of people — that everyone does their fair share and everything goes as planned… but then things start to go wrong. Deadlines are missed and project proposals are rejected. Publishers don’t like our book, and scientific journals aren’t compelled by our research. The truly successful, however, are persistent — they have plans, and backup plans, and even backups of backup plans. In the case of PIH, plan B involved coordinating the efforts of nonprofit organizations. Paul Farmer and Jin Kim managed to raise several million dollars to combat drug-resistent TB, and created demand for cheaper drugs through their successes.

Regardless of what projects we work on, we will always be the most passionate about growing our brainchildren. So we shouldn’t rely on any World Health Organizations, or drug manufacturers, or even nonprofits, to get us where we want to go. That’s for us to pursue on our own.