Beauty and the Sleeping Sickness Beast

The fate of people in poor countries afflicted with serious diseases depends not only on the cost of treatment, but also upon whether the disease also afflicts people in wealthier countries, or, in the case of sleeping sickness, whether the cure is also an effective beauty treatment:

The Scandal of 'Poor People's Diseases', by Tina Rosenberg, Commentary, NY Times: It's hard to imagine how a Rwandan woman with AIDS might be considered lucky, but in a way, she is. Effective drugs exist to treat her disease, and their price has dropped by more than 98 percent in the last six years. ... [T]he world takes AIDS seriously: rich countries provide money, drug companies have lowered their prices and accepted generic competition, and poor countries like Rwanda are scrambling to provide free treatment to all who need it. None of this is true for people who suffer from malaria, tuberculosis, or a host of other diseases ... like kala azar, sleeping sickness and Chagas disease... Most of these diseases are easily preventable and completely curable. Saving the lives of their sufferers is much cheaper and easier than treating AIDS. Yet millions of people die of them. Why the difference?

As fatal illnesses go, AIDS is the best one for a poor person to catch because rich people get it, too. The other diseases might as well hang out a sign: "Poor People Only." They offer researchers no profitable market. They have little political constituency. ... People with AIDS all over the world are fortunate to have fellow sufferers in America and Europe. They are even more fortunate that many are middle-class gay men. These men have lots of education, leisure time and income ... They are predominantly urban, well-connected and ultra-sophisticated. Their buying power provided pharmaceutical companies with a lucrative market for AIDS drugs. And they lobby. ...  Today, contracting a serious disease that affects only poor people is the worst luck of all.

I. How a Beauty Regime Salvaged a Cure for Sleeping Sickness ...After malaria, sleeping sickness is the most deadly parasitic disease. It is endemic in 36 African countries and is always fatal if it is not treated. The cure used in most places is melarsoprol – an arsenic-based drug so toxic that it collapses each vein into which it is injected and kills between two and eight percent of those who take it. There is another cure, eflornithine, so effective that it is called the "resurrection drug" – it makes people in comas get up and walk.

Eflornithine is an old anticancer drug that turned out to be not very effective against cancer. In the mid-1990's, the company that made the drug stopped making it. The fact that it was extraordinarily effective at treating sleeping sickness didn't matter, because victims of that disease had little money to pay for it. ... [B]y 2000, the existing stocks of eflornithine were dwindling and no other manufacturer was interested. It looked as though the miracle cure would disappear. Then lightening struck. Eflornithine reappeared in a six-page ad in Cosmopolitan magazine as the active ingredient in the Bristol- Myers Squibb product ... that impedes the growth of women's facial hair. Doctors Without Borders ... seized the opportunity to launch a publicity campaign. Christiane Amanpour went to southern Sudan to report on eflornithine for "60 Minutes."

The [company] which still controlled the rights to the drug, eventually agreed to donate a five-year supply, plus money for research, surveillance and training of health care workers, in a package totaling $25 million. The donation runs out this year, but there is a good chance it will be renewed. A Bristol-Myers Squibb spokesman inadvertently summed up the plight of sleeping sickness in 2001: "Before Vaniqa came on the scene, there was no reason to make eflornithine at all. Now there's a reason." The market agrees with him. Saving American complexions is a reason. Saving African lives, apparently, is not. ...

III. Why One Million Africans a Year Die of Malaria Malaria used to be common as far north as Canada and Britain. ... Shakespeare refers to it, as "ague," in eight of his plays. But today, ... Malaria is all but invisible despite the fact that it is one of the world's top killers... It is the leading cause of death for children under five in Africa. ...

International organizations and aid agencies talk a lot about malaria. But they have not backed their talk with money. The solutions they push have been things poor people can buy for themselves, because most donors are unwilling to finance more effective measures. All over Africa, a main cure for malaria is chloroquine. The great advantage of chloroquine is that it costs only a few pennies, so even poor African families can buy it. It just has one small problem – in most places it doesn't work. The parasite has become resistant to it. There is a new, effective cure, called artemisinin-based combination therapy. Countries should be switching to it rapidly, but they are not, because it's much more expensive – around $1.40 for an adult cure, 40 cents for a child. ... more than most malaria-stricken families can afford. That means rich-country donors would have to pay. Until recently, they haven't. ...

The hot prevention tool today is an insecticide-treated net to hang over a bed. These bed nets are very effective, if people can get them. But people can't... Even at the subsidized price of three dollars, the cost is high enough so that people living on a dollar a day do not buy them. One survey asked rural Africans what they would buy if they had the money. A bed net was sixth on the list. The first three items were a radio, a bicycle and, heartbreakingly, a plastic bucket. ...

The truth is that many malaria victims would be better off if America still had the disease. If malaria still existed in America, we would be attacking it with DDT . In fact, we did exactly that. ... This was extremely irresponsible and did terrible environmental harm. But now we know that DDT can beat malaria without environmental damage, if it is ... sprayed in tiny amounts inside houses. DDT, however, is banned in the United States and Europe. That means that Washington has not, until the last few months, financed its use anywhere else and it has blocked the World Health Organization from issuing recommendations to use DDT. American officials maintained it was hypocritical to push an insecticide overseas that is banned at home.

Americans are beginning to realize, however, that it is more hypocritical to deny Africa the ability to use responsibly the tools we used irresponsibly to beat malaria. Last year, President Bush announced a new program to ... provide an additional $1.2 billion over the next five years. ... It will give away bed nets, buy malaria drugs that work and finance indoor spraying. Eight countries in Africa are due to start spraying this year, and three will use DDT as their primary insecticide. ...

Comments

[Tim Lambert]

Argh! More rubbish from Rosenberg about DDT and malaria.

[bakho]

DDT, especially used indoors can be an important malaria control. However, malaria eradication in the US started LONG before the invention and use of DDT. Yes DDT was effective in wiping out the last vestiges of malaria from the SE US, but malaria was eliminated from large areas of the US by habitat modification, primarily, the large scale drainage of wetlands in the Midwest long before DDT burst onto the scene. DDT is inexpensive to make and any country willing to do so could easily make their own. Because of climate and other factors, malaria eradication is possible in temperate zones like the US but more intractable in tropical areas. Africa also has mosquito speciess that are the most efficient vectors of malaria and these species do not exist outside Africa. The problem is not the same.

http://www.cdc.gov/malaria/history/eradication_us.htm

[save_the_rustbelt]

Why did I know this would end up largely as a blame the U.S.?

The world hates us while expecting us to carry their lunchpail for them.

[anne]

http://query.nytimes.com/gst/fullpage.html?sec=health&res=9907E1DA1531F93AA35751C0A9679C8B63

February 9, 2001

Cosmetic Saves a Cure for Sleeping Sickness
By DONALD G. MCNEIL JR.

A cure for sleeping sickness, a disease devastating parts of central Africa, may soon be available cheaply because it has a second, profitable use: it eliminates facial hair in women.

The drug, eflornithine, is so effective at reviving even comatose patients that it is known as the resurrection drug.

The Bristol-Myers Squibb Company and the Gillette Company have just introduced eflornithine in a facial cream, Vaniqa, and Bristol-Myers is close to an agreement with the World Health Organization and the medical charity Doctors Without Borders for the companies to make an injectable form to treat human African trypanosomiasis, better known as sleeping sickness.

The disease, spread by the bite of the tsetse fly, drives victims mad before killing them.

It was nearly conquered in colonial times but has again become epidemic in war-torn central Africa; about 300,000 people are infected each year.

It has been known for more than 10 years that eflornithine is a virtual miracle cure for trypanosomiasis, but stocks have run out because early hopes that it would help fight cancer have been dashed and medical production has stopped. The last 1,000 doses, held by Doctors Without Borders, could be used by June.

The shortage is cited by critics of the industry who say multinational drug companies ignore the poor.

Now production of eflornithine is resuming as an ingredient in the face cream.

And if the talks succeed, Bristol-Myers, with the help of the Dow Chemical Company, Akorn Manufacturing Inc. in Decatur, Ill., and Aventis, a French-German company that holds the basic patents to the drug, will make 60,000 medical doses by June and donate them....

[anne]

Well, there was sympathy and admiration through Africa for America during the Presidency of Bill Clinton. There is still an appreciation of the American people, but everywhere in Africa a regret for what we have become in foreign policy. Early there was concern expressed about Africa in this Administration, but this has all but disappeared.

[anne]

http://www.nytimes.com/2006/01/20/health/20malaria.ready.html?ex=1295413200&en=26e92d251aeca291&ei=5090&partner=rssuserland&emc=rss

January 20, 2006

Drug Makers Get a Warning From the U.N. Malaria Chief
By DONALD G. McNEIL Jr.

Warning that misuse of the most promising new malaria drug could create an incurable strain of the disease, the new chief of the World Health Organization's malaria program demanded yesterday that 18 pharmaceutical companies stop selling some forms of the drug.

After several of the companies refused the demand, the official, Dr. Arata Kochi, made an unusually strong threat for an official of the health organization, saying he would publicly name the companies still selling the drugs three months from now and, if they persisted, would try to disrupt sales of their other medicines.

The new drug, artemisinin, a derivative of sweet wormwood isolated by Chinese scientists, is the most powerful new weapon in the antimalaria arsenal. Health agencies consider it the best hope for controlling the disease, one of the world's leading killers, which takes more than a million lives each year, mostly those of young children.

But these agencies say artemisinin should be used only in a cocktail with other malaria drugs, usually including a slower-acting one that lingers longer in the blood.

Combination therapy, which is routine with AIDS and tuberculosis drugs, not only attacks a disease more effectively, but slows the emergence of microbes resistant to drugs.

But at least 18 companies from Belgium, China, France, Ghana, India, Kenya, Switzerland and Vietnam make the drug as a pill that can be taken by itself, in what doctors call monotherapy, and sell it cheaply in Africa, Asia and Latin America. People with fevers often buy drugs at small shops without a prescription or a test to make sure that their fever is caused by malaria.

That is a recipe for disaster, Dr. Kochi said.

"We can't afford to lose artemisinin," he said. "If we do, it will be at least 10 years before a drug that good is discovered. Basically, we're dead." ...

[save_the_rustbelt]

Europe made a mess of Africa, so where are they?

They are alot smarter than us, just ask them.

And perhaps the billions of aid money alleged to have been stolen by various dictators would be useful.

So, rather than being cranky, someone should be putting together a multinational coalition to do two things in Africa:

1. improve drinking water
2. combat malaria

I suggest the European Union take the lead with our support.

[anne]

America's image could be readily changed by leaving this terrible war and occupation in Iraq which is costing us so dearly in so many ways, and attending to needs internationally for which we will be properly appreciated. Imagine what might be done home and abroad with even a small amount of the more than $2 billion a week spent on Iraq.

[anne]

Absolutely; Europe has historically behaved terribly in Africa and should be coaxed and even bullied for increasingly sensible support.

[peterbob]

The lack of international aid for medicine and disease control may be partially the fault of the recipient country. I don't know exactly how foreign aid works, but I imagine it works something like this:

Donor: We are going to support you and give you aid. What type of aid do you want?

Recipient: We would like cash or weapons.

Donor: Would you like medicine?

Recipient: No, we would like cash or weapons.

[anne]

No; cash grants or loans are only tied to specific programs and military assistance is highly concentrated and program based. Interestingly enough there are many governments that reflect a concern for citizens, and accept and use aid appropriately even when there are threatening domestic problems.

[David]

Diseases are one of the biggest problems in every country. Sometimes if a certain place in a country experience an outbreak of disease, the government is the one that is blamed. I think we are all liable to this kind of problem. All we need to do is to prevent those diseases. The government also needs to be responsible to protect their people. It is said that health is wealth. For us to have a successful life, we need first to take care of ourselves.

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