Physician discusses disease, equity

Dr. Paul Farmer delivered a lecture titled “The Pathologies of Power: Rethinking Health and Human Rights in the Global Era” Friday at 4 p.m. in Brooks-Rogers Recital Hall.

The noted infectious disease physician and anthropologist – a member of the organization Partners in Health – discussed his quest to provide medication to the impoverished throughout the world. His lecture focused on the high rates of disease, particularly tuberculosis, in developing countries.

Farmer began his lecture by introducing the work he and his organization have done in Haiti, which is presently suffering an epidemic of multi-drug-resistant tuberculosis (MDR-TB). Many experts strongly oppose expanding treatment programs to include tuberculosis’s drug-resistant strains. According to a 1997 statement by the World Health Organization (WHO), “MDR-TB is too expensive to treat in poor countries; it detracts attention and resources from treating drug-susceptible disease.”

Farmer responded to these claims by citing evidence of his success and by criticizing the policies of so-called “experts” making decisions for the world. One concern of those opposed to treating drug-resistant tuberculosis is that patients who refuse to complete treatment will make for a low “cure rate.” However, Farmer said that 85 percent of his patients had been cured. The remaining 15 percent, he said, included many patients who received treatment too late.

According to Farmer, the number of patients refusing treatment decreased dramatically as evidence of the treatment’s effectiveness accumulated.

Farmer’s responded to his opposition’s stance that the treatment of drug-resistant tuberculosis is “not feasible, not sustainable, not possible [and that] all patients will cop out” by asking the audience to consider how a similar epidemic would be handled in a developed area. He added that positions such as the WTO’s were developed by speculation and hearsay. The “experts” had neither visited the affected areas nor tested treatment methods.

The WHO currently supports the Direct Observed Therapy Short-Term (DOTS) treatment program. DOTS consists of a closely supervised treatment for six to eight months geared to control tuberculosis, but it lacks a component for drug resistant strains of tuberculosis.

DOTS-Plus, the progressive method of treatment supported by Farmer and Partners in Health, includes treatment for the drug-resistant strains. The drugs required are not too expensive because they are now off patent, and the DOTS-Plus program is not too difficult technically: it was successful in both Haiti and Peru.

The complaint most strongly refuted by Farmer is that DOTS-Plus is not cost effective. His logic is that if a drug is cheap, but ineffective, it costs more than a more expensive and effective drug. He complained that he was “being scolded for treating people with AIDS.”

Although the lecture focused on the treatment of tuberculosis, Partners in Health treats many illnesses of people living in poverty, including HIV and AIDS.

Farmer closed his lecture with good news: Partners in Health had just received a large grant. However, he was reluctant to be too joyous. “One disease, one project,” he said. “There are four citizens of the world more wealthy than forty-three countries. It is critical to recall that the intent of this lecture was health and human rights. This health issue’s significance is based upon the basic human right of health and well being.”

Farmer concluded by quoting article 27 of the Universal Declaration of Human Rights, which declares, “Everyone has the right freely to participate in the cultural life of the community, to enjoy the arts and to share in scientific advancement and its benefits.” In ending his lecture with a statement he believed difficult to refute, Farmer clarified the necessity for equality in health care.

An associate professor of social medicine at Harvard Medical School and director of Harvard’s Program in Infectious Disease and Social Change, Farmer has been described as a clinician, a researcher and an advocate. He has both an M.D. and a Ph.D. in anthropology.