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Dracunculiasis. You don’t want it. Look down at your kneecaps or where your thumb joins your hand and imagine big white worms — two feet long, some of them — emerging from the pores. It’s painful and crippling. Twenty years ago, 3.5 million cases of this parasitic disease — aka guinea worm — were reported annually, mostly in parts of Africa where sanitation is poor, resources are scarce, and civil strife prevents local leaders from thinking about public health. Now, guinea worm is on the verge of eradication, with only 25,000 cases reported last year.
What is remarkable about this, as Michele Barry, MD, notes in the New England Journal of Medicine, is how a low-cost intervention has circumvented so much suffering. The larvae are consumed through contaminated drinking water; the mature worms exit the body of the infected person a year later. The solution lies in a tightly woven water filter made by DuPont, coupled with a massive effort coordinated by the Jimmy Carter Center to educate native peoples about its use.
Sixteen years ago, in my days as a general assignment reporter, I had the privilege of talking with former President Carter about his effort to eliminate the scourge of the guinea worm. I was horrified by his description of the problem, struck by the simplicity of the remedy, impressed by his passion, and charmed by his famous smile. I also remember thinking to myself, “Persuading millions of people to use this filter before drinking the water? Good luck with that.”
I stand corrected.
Parallels are found in our story herein about genetic tests that may predict whether a person will respond to a biologic drug. Biologics offer the hope of remission or cure for many debilitating afflictions that traditional medicine either cannot or never tried to address. They are powerful products, and this characteristic — along with their cost — compels the healthcare system to ensure that they are used appropriately. In the absence of such a test, a biologic is often prescribed on an educated hunch that may pay off but poses risks for patients and payers.
The testing industry has been perfecting its wares and engaging payers in an educational blitz about the value of its relatively low-cost interventions. MCOs are hesitant to pay $3,000 for a test without proof of efficacy, even if it means prescribing a $25,000 drug blindly. But, slowly, the education effort and the emergence of tests with better sensitivity and specificity are beginning to result in greater payer acceptance of tests. Ultimately, this may open access to innovations that could mean a better life for millions who could benefit while preserving precious healthcare resources.
The same principles guided the guinea worm eradication effort.