Letter Medical research into "neglected diseases"
MJA 2001; 175: 667-668 | |||
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To the Editor: Doctors were once leaders in developing therapeutic
breakthroughs. From Robert Koch's discovery of the tuberculosis
bacillus in the late 19th century through to Fleming, Salk and Sabin,
medical researchers have been behind many of the most important
advances in medical science.
How the mighty have fallen. Medical researchers now scrabble for scarce public funds to conduct the basic research on which future therapeutic advances will be built. And, should they be successful in securing funding, they know that, in the absence of any clear commercial application, the fruits of their research are likely to be shelved. Today, the development of promising therapeutic avenues or compounds is entirely at the behest of market imperatives: will the potential market outweigh the potential development costs and deliver a good return to shareholders? Non-profitable medications or approaches, no matter how valuable in health terms, are not a priority. In this equation, medical opinion carries no weight. The consequence is not only a loss of influence for the medical profession, but also a life-threatening dearth of medicines for non-profitable consumers — or, to put it bluntly, for 95% of the world's population. Practitioners treating common diseases in the developing world, such as tuberculosis, malaria or sleeping sickness, are forced to use drugs dating from the 1940s to the 1970s (or, in the case of suramine for sleeping sickness, from 1917!). In a recent presentation at the World Conference on Clinical Pharmacology and Therapeutics, Fred Hassan, CEO of Pharmacia, shed light on drug company thinking. He chided the pharmaceutical industry for its more inclusive approach in the past, "which focused on therapeutic areas across geographical regions", and urged them to "strategically concentrate resources and top management attention on . . . a smaller group of key products . . . and on success in the US and just six or seven other critical markets". This was, he said, the new paradigm for success in the pharmaceutical industry. The results of a purely market-driven approach are clear. In the past 25 years, the pharmaceutical industry has developed only four drugs to treat tropical diseases that collectively kill millions of people each year: atovaquone/proguanil, for malaria (originally indicated for Pneumocystis carinii); artemether, for malaria (developed in conjunction with World Health Organization funding); eflornithine for sleeping sickness (a by-product of cancer research, withdrawn from production between 1995 and 2001 because it was insufficiently profitable); and nifurtimox, for sleeping sickness (originally developed for veterinary use). Society and governments are also responsible. They have accepted that drug development can be confined to the private sector, even though the withdrawal of public funds clearly seals the doom of research into drugs for neglected diseases. As doctors, we should be ashamed at the prospect of allowing our erstwhile noble profession to sit by while global health issues are decided by drug company marketing imperatives and public funding neglect. Is the only solution to keep our eyes firmly lowered to our prescription pads? Or can we — should we — speak out on behalf of the millions who die each year from treatable, infectious diseases, killed not by bacteria or parasites, but by public neglect and private apathy? Mary K Moran,* Catherine M Hewison,
©MJA 2001
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