An Epidemic of Neglect: Neglected Diseases and the Health Burden in Poor Countries. (Patently Abusive)

Article excerpt

CARDIOVASCULAR DISEASE AND CANCER, baldness and impotence -- in recent decades, innovative drug treatments have helped mitigate or cure everything from life-threatening disease to the unpleasant marks of aging. But this "health revolution," which has resulted in considerable gains in life expectancy and health improvements in some parts of the world, has left most of the world's population behind.

Drug research and development (R&D) for diseases that disproportionately affect poor people in developing countries diseases is at a virtual standstill. According to a study by Patrice Trouiller and colleagues, soon to be published in the Lancer, of the 1,393 new drugs approved between 1975 and 1999, only 16 (or just over 1 percent) were specifically developed for tropical diseases and tuberculosis, diseases that account for 11.4 percent of the global disease burden.

Doctors Without Borders/Medecins Sans Frontieres (MSF), the international humanitarian organization that was awarded the 1999 Nobel Peace Prize, has called attention to the problem of "neglected diseases." These are seriously disabling or life-threatening diseases -- such as malaria, tuberculosis (TB), Human African trypanosomiasis (sleeping sickness), American trypanosomiasis (Chagas' disease), and visceral leishmaniasis (kala azar) -- which mainly affect people in developing countries, for which treatment options are inadequate or do not exist, and for which R&D is insufficient or non-existent.

Those stricken with neglected diseases do not constitute a valuable enough market to stimulate adequate R&D for new medicines by the multinational pharmaceutical industry.

With a global system that relies on private companies to bring drugs to market, this situation has left much of the world without prospect for treatment and cure of the diseases that take a dreadful toll on their populations.

However, there are now, for the first time, glimmers of hope on the horizon. With public health campaigners drawing some international attention to the problem of neglected diseases, a number of diverse initiatives have been launched to spur R&D into these illnesses. But these new efforts are unproven and poorly funded, and some are pursuing controversial partnerships with industry. Their ultimate, or even partial, success is far from assured.

THE BURDEN OF NEGLECTED DISEASES

According to the World Health Organization, 14 million people die each year from communicable diseases such as malaria, TB, sleeping sickness and kala azar. An estimated 97 percent of deaths from communicable diseases occur in developing countries, with the poorest people in those nations disproportionately affected. Infectious and parasitic diseases account for 25 percent of the disease burden in low-and middle-income countries, compared to only 3 percent in high-income countries. According to the World Bank, eliminating communicable diseases would dramatically close the mortality gap between the richest 20 percent of the world population and the poorest 20 percent.

In many instances, the ravages of communicable diseases are worsening. Old diseases are reappearing and drug resistance is spreading rapidly, rendering useless medicines that were once effective. Some of the medicines used today were invented decades ago and are highly toxic. For some diseases, there is no treatment to offer: no effective medicine has been found and nobody is looking for new possibilities.

Sleeping sickness is a primary example. A parasitic disease that affects 36 countries in sub-Saharan Africa, an estimated 300,000 to 500,000 people are currently infected with this disease, and the figure appears to be on the rise. Left untreated, sleeping sickness is 100 percent fatal. It kills more than 65,000 people each year.

In many places, melarsoprol has been the only treatment available for second stage sleeping sickness. Developed in 1949, melarsoprol is an arsenic derivative so toxic that it kills one in 20 patients. …