In Search of New Ideas for Global Health
Mar. 28, 2008 by Lisa Currie
From the New England Journal of Medicine…
Perspective by Tadataka Yamada, M.D.
The recent failure of another potential vaccine against human immunodeficiency virus (HIV) underscores the enormous challenges of tackling diseases whose heaviest burden falls on the developing world. A quarter of a century after the first report of AIDS, our knowledge about how an HIV vaccine might work is still distressingly limited. It seems clear that neither current dogma nor traditional thinking is likely to get us to the next step. Truly creative ideas will be required. I must confess to having learned the hard way that embracing new thinking, as difficult as it may be, is crucial for the advancement of science and medicine.
As a gastroenterologist, I was one of the many who believed as gospel truth that peptic ulcers were caused by gastric acid. When two scientists from Australia came along and argued that it was actually a bacterium, Helicobacter pylori, that produced ulcers, those of us in the “Acid Mafia” rejected their claims out of hand. But Robin Warren and Barry Marshall persisted. Marshall even drank a solution of H. pylori, became ill, took antibiotics, recovered, and wrote a paper about it, just to get others in the field to pay attention. You know the ending to this story — these scientists were proved right and went on to win a Nobel Prize in 2005.
New ideas should not have to battle so hard for oxygen. Unfortunately, they must often do so. Even if we recognize the need to embrace new thinking — because one never knows when a totally radical idea can help us tackle a problem from a completely different angle — it takes humility to let go of old concepts and familiar methods. We have seemed to lack such humility in the field of global health, where the projects related to diseases, such as HIV, malaria, and tuberculosis, that get the most funding tend to reflect consensus views, avoid controversy, and have a high probability of success, if “success” is defined as the production of a meaningful but limited increase in knowledge. As a result, we gamble that a relatively small number of ideas will solve the world’s greatest global health challenges. That’s not a bet we can afford to continue making for much longer.