Medicines in the 21st century or pills, politics, potions, and profits: Where is public policy?

The delivery of health care over the past century, including drugs for the past 60 years, has brought significant gains to the overall health of the world population. The recent advances in genomics carry the promise, as yet not fulfilled, of far greater benefits perhaps, as far as molecular medicines are concerned of actually delivering Paul Ehrlich's "magic bullet." However, the delivery of currently available health benefits to the world has been remarkably non-uniform and the major fraction of the world's population still remains inadequately served by basic public health services, including clean water and sanitation. Additionally, this same population is devastated by diseases including malaria, tuberculosis, and AIDS. This discrepancy in health care parallels the economic disparities that exist between nations and that are in fact increasing rather than decreasing. The absence of health care is a driving force for the generation and maintenance of poverty. The issue is less science than it is public policy and the will of the rich world to generate the infrastructural environments under which the rewards of science can be shared equitably. The delivery of biomedical science in the future is discussed both in terms of the science that will drive advances and the public policy issues that must be implemented to ensure delivery of scientific benefits.