A debate about medical ethics how much should we spend on expensive treatments especially when theyre so new that its not certain theyll be as effective as hoped. Im sumi so much going to thank you for joining us we start with what appears to have been a breakthrough in efforts to secure a truce in the civil war in libya German Foreign minister heikal moss has announced that the powerful rebel leader star has agreed in principle to abide by a cease fire now the country and its backers they are split between 2 rival governments one of those governments is in tripoli that is the seat of the u. N. Backed government of iraq the other is based in tobruk which is the base of the Libyan National army led by general holly for huffed are germany and the European Union are pushing for stability in libya to help stem the flow of migrants who are making the journey across the mediterranean but it is a multilayered conflict and there are no easy solutions. Our strongman general highly for hafter wants tripoli. Together with his Libyan National army he hopes to capture the countrys capital and take full control of this oil rich nation. And its partly because of oil that russia and turkey have waded in on either side of this conflict with turkey behind fires alsa rajas un backed government and russia supporting have to. Moscow has denied reports it sent a messenger is to reinforce the generals fighters but on thursday turkey confirmed it had started deploying troops to help in tripoli despite a un arms embargo. With libyas so unstable the fear of resurgent islamist terror has worried many European Countries but other factors mean the e. U. Is split over its alliances. Officially the tripoli based government has the backing of europe including germany but italy has openly supported general have to who it sees as crucial in stemming the flow of migrants across the mediterranean and frances concerns over terrorism as well as its interests in libyas oil wealth has pushed towards with the use of fish or line there are claims its given Covert Military help to general hafta earlier this week peace talks in moscow broke down. Despite the many interests at stake and the players involved germany seems determined to pursue its mediation role. But even if a ceasefire is agreed the road to peace looks long and bumpy. Lets get some analysis on this story now we have with us hes the managing director of global strap thats an International Security and geopolitical Risk Consultancy firm over thank you very much for joining us here in studio 1st of all this question do you think there will actually abide by this cease fire. Starve the track record is not very good i mean weve seen my course try to be the main between siraj the un backed government and after are. Even were after a communique of a cease fire of an agreement Nothing Happened because both sides didnt sign and so we have to make sure that when it comes to berlin well actually sign the piece of paper along with raj but at the same time. Has no inkling to basically have a ceasefire ease winning on the ground more than before because of the help of the russians of mercenaries that putin has sent about 2000 people from wagner but at the same time as youve seen turkeys becoming extremely involved in sending also this week 2000 syrian mercenaries so we have the risk of a major escalation between extremely motivated and well trained people who could have a bloodbath in tripoli and thats why the International Community is trying to put an end to this what about the peace conference this weekend here in berlin a lot of people are saying this is such a multi layered conflict the fact that all these sides are coming together to a table to speak including general half hour is in itself a victory and how do you see this it has to happen in the past i mean the french and italians were extremely successful to put gold of people around the table but when it came to action Nothing Happened so yes its going to be a p. R. Coup to say look everybodys coming to berlin but at the same time on the ground things are extremely fluid and also you have on both sides patrons are giving the orders we know that in moscow the cease fire didnt get signed between off because egypt was pushing for after not sign it was a big setback for your 14 that it didnt happen because hes hes playing both sides russia is playing both sides theyre edging their bets at the same time here in berlin the fact that. America is now getting involved is the 3rd actor if you will within the e. U. That is pushing for this i dont think shell have a miracle recipe that the whole or the tally and try to. Were the German Foreign minister say that if developments in libya are allowed to continue then libya will become the next syria and nobody wants that to happen. What is at stake on the ground here what are we talking about libya is much more complicated than syria if it can be but it is it is much more dangerous and it has a much closer tie to europe so its a triple layer risk the 1st one being that this war goes on protracted for another 10 years and its a proxy war so you its basically world war 3 by proxy in libya because on one side you have egypt the u. A. E. Saudi arabia friends and russia on the other side you have qatar turkey and russia. The u. S. Was involved at one point in 2016 to get rid of Islamic State so the 2nd risk is Islamic State using this opportunity of the fighting between soraya and after to come in and regroup and weve had information this week that about sars and fighters from Islamic State in need to leave syria settled in libya ok so they want to rekindle Islamic State there ok so definitely a lot at stake there all iraqi time managing director of Global Global strategy so much for joining us here in studio now to some other stories making headlines around the world irans Supreme LeaderAyatollah Ali Khamenei has addressed the nation during friday prayers for the 1st time since 2012 he called irans airstrikes against the u. S. In the killing of general concepts of the money a day of god. At least 11 american troops were injured when iran attacked a u. S. Base in iraq the u. S. Central command command has now confirmed america had previously claimed there were no casualties in the attack which was in retaliation for the killing of a reigning in general so the money. Ukraines Prime Minister all lexy one shot of has submitted his resignation in a Facebook Post he said he had offered his resignation to the president flood damage selenski the move comes days after one child oak was caught on tape saying the president knew nothing about the economy on track says the recording had been doctors. Now to australia which after weeks of devastating bush fires is now having to cope with flash floods heavy downpours in the east have suppressed the bush fires at least for the time being but was more rain forecast for the coming days australians are finding themselves moving from one weather driven crisis to another i from flames to flash floods just a week ago stuff of this nature park were protecting their animals from oncoming bushfires now theyre having to deal with another extreme theres the driver who was also said absolutely inadequate. Never go to the whats coming in the park a wall of water. Starts rushed koalas to safety. Back might be. Well for creatures more used to the way it was more about keeping them in their place. For heavy rain has fallen across New South Wales one of the states worst affected by bushfires in the state capital sydney residents were remembering how to use an umbrella the orange hair use that have taken over the citys skyline now cloudy grey. We need a bit of rain in order to help defies procedures how dry it was part of that is that i think you would hope would behave as this push everything out there this is what its value in many many months weve only had about 4 days of rain in the last almost. And not run of only children go others will go well and truly the world. For many in the country the wet weather has relief and joy. More a case of sliding than singing in the rain. That rain has helped thaw of the raging bushfires but it does bring with it another set of dangers with the land so dry and vegetation burns away water just bounces off the ground 1st firefighters here are well aware changing weather doesnt automatically mean changing fortunes. Here watching news still to come jihadists blasted it with dynamite and loses its treasures the archaeological legacy of afghanistans army and valley is now facing a new threat climate change. But 1st Pharmaceutical Company novartis has announced that it will use a lottery to supply the worlds most expensive drug to children suffering from a devastating genetic disease called spinal Muscular Atrophy but only 100. 00 children will receive the free treatment which usually cost millions of dollars the astronomical price of such drugs has triggered an ethical debate. Michael story sounds like a modern fairy tale but it also poses questions he was born with spinal Muscular Atrophy a life threatening neuromuscular disease when his condition deteriorated despite treatment his family launched an Online Fundraising campaign that aim for him to receive a gene therapy thats not licensed in europe yet gets the opportunity. The treatment cost almost 2000000 euros professional athletes and celebrities lead their support bowing to pressure from the public the Health Insurance company agreed to pay michael received the most expensive therapy in the world. But that. Grew thinner and as it was a miracle that it worked at all then on the 3rd day we had another miracle that he could turn himself over properly and in the 2nd week he even sat up on his own. The joy was shared by very many online supporters but there are other opinions about the treatment some say not enough tests have been done to guarantee its safety more parents have been demanding access to it Health Authorities are sounding the alarm. This is about our promise over here way and i really hope its one that will be for bill but we still dont know if it will be and so this is a game of hope of one happening outside the normal system so its not how we should be doing things the system then the manufacturer novartis has issued a statement on its product the decision to implement the therapy must be made by specialized doctors under careful consideration of the risks on an individual basis and we are prepared to offer financial concessions to Insurance Companies. But this Case Highlights another major question in a Public SectorHealth Care System how much may a treatment cost many expensive gene therapies are set to gain market approval in the coming years what kind of results justify what kinds of costs at the University Hospital in bonn dr young band kirshner meets families who have the prescription that costs 2000000 euros he says it doesnt make sense yet to start prescribing the therapy on a wider scale. Think it is one of the. Very new kinds of therapies where were not sure how effective or safe they are we need consensus between all parties between specialists doctors experts centers Insurance Companies and licensing authorities only then can we properly decide which patients we should treat with a therapy thats at such an early stage. Michael seems to be doing well so no one knows if the 2000000 euro medication has really healed his disease for good still his story shows how vital it is to regulate costly new gene therapies. A story that raises a lot of questions that were going to talk about with our science reporter Karen Williams and our religious Affairs Correspondent martin good to have you both here in our studio dark and to start with you can you explain how this treatment actually works well this is a completely different kind of treatment than generally comes out of the pharmaceutical industry this is the treatment indeed healing a genetic disorder not genetic disorders cause mean if you have a genetic disorder its down to a faulty gene which isnt producing a particular protein correctly and the lack of that protein can have a greater or lesser impact on your health now what this these kinds of treatments to gene therapy treatments do is they replace that faulty gene with an intact copy of the gene and they do that using viruses they inject inject viruses into your body which are able to enter the cells and add themselves to your d. N. A. So that from that point on your cells have an intact copy of the d. N. A. And they can produce the protein properly now so ultimately what that means is that this is at least in theory a one shot treatment that heals it after that your body continues to make the protein properly in your diet and your condition is taken care of and it seemed to be effective at least short term it hasnt been around for that long the question is whether or not it really is going to last forever whether its going to be or if theres going to have to be there going to have to be booster shots along the way thats one of the Big Questions actually in this debate and there are also ethical questions that this gene therapy it raises i mean what do you think the biggest ethical concerns are here i mean obviously one of the biggest issues that we have is that we are facing other misstating illness that affects children intuitively one would see this and immediately sort of you know removed the same time we have. A drug that costs essentially a small fortune for a bar and or for a country for Health Systems for actually the ploy so i think that at the forefront of those gushingly is a question of us you. Access to medicine and access to cures especially in light of new technologies that is a question that people are asking specifically of this homicidal company why does this therapy cost so much money well you have to its not its not only no vargas its a question of the pharmaceutical industry the Business Model that its based on its not based on giving us one shot treatments that heal us the fall pharmaceutical industry is based around Health Care Management its based around producing drugs that then continues to possibly sell you for the rest of your life that will eventually allow them to recoup the cost and compensate them for the work that they put into that into the research and development of that particular drug you cant forget that the research and development for every 10 drugs that are that are that are in testing only one drug will actually make it through to the end in fact the pharmaceutical industry says that each and every drug that gets develops nowadays costs upwards of 2000000000. 00 euros before Development Costs before its actually on the market so theres that aspect of it and they say that we have to recoup those costs in order to drive further innovation is that there were sponsibility market well its actually a very good question its one that i dont think can be solved by a Single Person sort of making moral or making scientific claims the one thing that i think we should be warned about particularly because of the heater of from a Studio Company is that the claims about the cost of development should not be taken at face value if you please true that were all being called to participate in essentially supporting the companies that are developing to slave saving cures then it is important that we see that as a matter of fact these are the costs of stake at the very same time there is a 2nd argument that is very usually the bloated buy buy from a Suitable Companies which is that there are no charges not only they have to recuperate the cost of the element but as a matter of fact they are in the business of making money and i think that this is sort of a problem that is certainly a major ethical problem with this drug because of the pricing and illness that is a tax but its a questions i think that more broadly put to the pharmaceutical industry i think that children are have an intuitive and under. Standing off the fact that we should not be in the business of taking advantage of people in a position of suffering and when we have an industry that pretty creates a Business Model on the idea that bruff it is going to be extracted directly for people that are in a situation of suffering i think that we face mean a 1000000 at the go dilemma if in fact we have a moral dilemma for most people they would say there is no the limit although its very clear that this is wrong in this case were talking about dead children to put it in a way that maybe 6 plosive but i mean i really want to conjure the mage so stage the question becomes either a lot more complicated or a lot simpler the ending where you stand i think well i think the position medicine which is what this field particularly is is really causing us to ask basic fundamental questions about the monetization of health care in general i mean. A pharmaceutical product a medicine thats potentially lifesaving its not a product in the sense that we would think of say an i phone we have to but we still treat it in that way economically and in the Business World its a business its its about making money and the question is is that system has been in place for a very very long time monetizing health care b