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).










Good news for book publishers—and readers of books!
By Tom Hallock
My friend Johanna Vondeling, editor of many of my books over the years, recently posted this article on Facebook. I thought it worthy of wider attention here. The author, Tom Hallock, is Associate Publisher at Beacon Press and a friend of Berrett-Koehler Publishers, where Johanna is Vice President. She reports that Hallock recently read Steve Piersanti’s “10 Awful Truths About Book Publishing” (posted here). He thinks Steve makes good points AND he wanted to point out some good news for publishers amidst all the recent change in the industry. “His ideas are spot-on and inspiring,” Johanna wrote.
1. Publishing is generally maintaining revenue during its digital transition, something most other industries have been unable to do.
2. There is a new efficiency in the industry causing returns to be dramatically reduced. Digital content, short run and print-on-demand manufacturing, the rise of direct and online sales and an improved supply chain have all reduced the impact of an industry practice that has been a drain on profit. This reduction of waste has also lowered our environmental impact.
3. Our content can be monetized in more ways than ever: eBooks, other digital content, digital download audio, etc.
4. Media continues to be most responsive to big new ideas that are first introduced in book format.
5. The need for investment in physical inventory has also been reduced by all the factors mentioned in #2 above and because we are less reliant on physical display in bookstores.
6. Publishers do not require the physical display of books in order for readers to find them. The 24/7 availability of all books everywhere through our own web sites and those of online booksellers means that readers have instant access to our titles when events, or media attention, or broader shifts in the culture create interest in them.
7. The international market has opened up and is providing access to readers throughout the world whether or not they have access to a physical bookstore that carries English language books. Readers discover books through multiple sources, most of which don’t recognize borders.
8. There is almost a daily growth in tools to build community and reach readers. In particular our ability to aid readers in discovery through BISACs (a Book Industry Study Group subject heading classification), metadata, keywords—as well as social media—has to some extent freed us from the activities of intermediaries and empowered us to grow our businesses.
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