I am not familiar with this subject at all; but a small write up on this made 
me think. 
There are some rare diseases affecting a numerically very small segment of a 
population. Though search for the cure of a rare condition affecting eye and 
neck muscles led to the discovery of Botox, the anti-wrinkle agent, that has 
become a big business (including bootlegging of the substance), the search for 
the cure of such rare conditions are not undertaken by big pharmaceuticals.
It makes whole lot of sense in a capitalist market system which is driven by 
profit-motive. So, factors like huge cost of R & D, clinical trial and 
gestation period keep the financiers at bay. More so, when the chance of 
success with the project is uncertain, and the  recovery of cost is dim due to 
the small size of the affected patient population. So, any researcher would not 
easily find a funder and the big pharmaceuticals would surely shy away, 
notwithstanding the fact that such research had yielded valuable knowledge, and 
in some cases bonanza,  in the past.
So, if the things are left to the invisible hands of the market forces, the 
ideal form of capitalism, it would mean and imply that those damned by the rare 
conditions would not stand a chance, unless of course some freak finding in 
other field of research come for their deliverance. 
On the other hand, even those who believe in capitalism as the ideal, and in 
fact considers it as the end of history, would consider this condemnation of 
the small segments of population, afflicted by rare diseases, as cruel.  
To avoid this cruelty, even the citadel needs some contamination! The 
legislators' hands have substituted the invisible hands of market forces in the 
US, where an Act (Orphan Drugs Act) has been passed recently to give market 
exclusivity to a big pharmaceutical, which would involve itself in such a 
project, along with some other incentives. This may woo investment the rare 
diseases' way, because, in spite of the small size of an suffering population, 
market exclusivity would help the pharmaceuticals recover the cost with 
profits, and it may mean a windfall in case something like Botox comes up. No 
doubt, here too 'search for profit' would be the mainstay of ensuring finance. 
But the fact remains that it creates some sort of level playing field for small 
communities affected by rare diseases and the rest of the people affected by 
abundant diseases.
As an aside, it may be added that in India, the Constitution, makes room for 
concepts like 'reservation' 'autonomy' 'exemptions' etc. for certain categories 
of people with the declared goal of providing some sort of level playing field 
and also for protecting them from some misfortune, as groups. 
Though such measures may seem odious from an elitist and advantaged view-point, 
and has in fact led to gross abuse primarily due to the nature of the ruling 
polity in India, those measures by themselves, may not qualify for loathing, as 
an elitist view of the matter would suggest.


P.S. To Ram Sarangapani & Deepankar Medhi: This seems to be an incurable trait 
in me; I fail to see the benefits of of compartmentalization. 
Uttam Kumar Borthakur

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