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The most important question isn’t finding a conspiracy to finger-it’s finding out whether we’re ready.How prepared will we be ifWest Nile evolves into something more virulent, or if something much nastier turns up? The major pharmaceutical companies have largely ignored, curtailed or terminated programs to develop drugs against infectious diseases that predominate in the unremunerative, Third World markets where millions perish each year from devastating infectious diseases. True, the Bill and Melinda Gates Foundation has donated $750 million to expand vaccine use in developing countries, and Merck and three other drug companies recently announced plans to donate $100 million worth of vaccines for poor children. But wouldn’t it be nice to feel that such magnanimous gestures
occurred independent of either federal antitrust lawsuits or growing public discontent over the price of drugs? interest in curing the infections problem for us all.

A cynical friend of mine has complained for years that it is in the economic interests of drug companies to avoid finding cures for diseases, because it’s bad business. The perfect drug, from their point of view, he argues, is one that never cures the underlying condition and must be taken for a lifetime. I’ve tried to disabuse him of this view, but when I see “lifestyle” drugs and maintenance therapies relentlessly pitched on TV (and now we’re getting back to that Knicks game), it’s getting harder to argue the point. The “crown jewel” of Pfizer’s recent $90 billion takeover ofWarner Lambert was Lipitor, the cholesterol-reducing drug that is anticipated to rack up a staggering $5 billion in sales this year. Given the recent blitz of advertising for Propecia,Viagra and Prozac, you’d think the loftiest goal of biomedical research these days is to make everyone hairy, horny and happy-rather than healthy.

We don’t need to vaccinate New Yorkers against West Nile encephalitis-not yet, at least. It’s too early in the story, and the numbers are surpassingly small. But the subtext of the West Nile epidemic-indeed, the epidemiological confusion that led to its initial misdiagnosis-is the notion that it can’t happen here. Clearly, it can.And just as clearly, there may be other, more infectious and virulent pathogens, seemingly tethered to the poverty and deprivations of the developing world, which could give a new and sickening twist to our embrace of globalization and for which we are unprepared.

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