Archive for August, 2012

When India made its patent law…

#STOPNovartis

The rules of the game all changed when India designed a patent law that was very restrictive on which medical inventions should be patented. A decision taken in the interest of public health, as fewer patents mean increased access to affordable medicines. Generic medicines. Those that countries in the developing world have come to count on. The country supplies a vast proportion of affordable HIV/AIDS and Tuberculosis medications and is the second leading provider of medicines distributed by UNICEF. India is literally the “pharmacy of the developing world”.

Nevertheless, one of the most significant trends in pharmaceutical patenting today is the move towards harmonising patent laws across different countries and continents. For several decades now, the pharmaceutical industry has been pushing for the stricter patent standards of Europe and North America to be extended to the developing world. This to a large extent has been done through the World Trade Organization’s TRIPS Agreement.

Now things are coming to a head.  The case — Novartis versus the Indian Government — is in its final stages, with final arguments pushed back until 11 September. The case is complicated. Much more complicated than the layman’s arguement of “if India can make the drugs cheaper why can’t Novartis?”. The second pill is cheap to make, the first costs millions if not billions in R&D.

MSF are the leading voice in advocacy on this situation, and are very vocal on demanding acces to essential medcines for all. With lives at stake versus Big Pharma profits, it’s hard to come down on the side of Novartis. Competition among different producers is the tried and tested way to bring prices down. And, in this case, this can only happen when the patent doesn’t intrude. But let’s not be mistaken; India does have a patent law, and for the most part it protects innovation. It’s just that the bar is set a lot higher than in some other countries. Big Pharma has a trick — termed “evergreening” — that it uses to keep patents fresh on its money-making drugs. Minor improvements to old medicines make sure the company that produced it stays exclusively rich.

We’ll see which side the Indian Supreme Court comes down on. Defending and protecting intellectual property is important for innovation. But health should not be commerce. Whatever the decision the impacts will not only be measured in cents and dollars — but also lives. Almost makes the Apple vs Samsung legal battle seem almost trivial.

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Fear of Ebola…

“…the last big outbreak I experienced in Uganda [was] in 2007. When MSF arrived a lot of the staff in the hospital had died and the rest had run away because they were scared.”

– Dr Kamalini Lokuge, who is about to head off to Uganda with MSF to fight the latest outbreak.

At the end of July, the Ugandan ministry of health notified the WHO of an outbreak of Ebola haemorrhagic fever in Kibaale district in western Uganda. Since the beginning of July, 24 cases — a mix of probable and confirmed, including 16 deaths have been reported (only 10 cases have been laboratory confirmed).

Even though just 2,306 cases have been reported since the disease was first recognised in 1976 in the country formerly known as Zaire (now the Democratic Republic of Congo), the virus kills two in every three.

Ebola is also a virus that works against its own best interest. It kills quickly — within the first week of August, the outbreak had already claimed the lives of 16 people. And because of this simple fact, most outbreaks aren’t long-lasting and are self-limiting. But the simple way in which the virus passes from one person to another (transmission between humans taking place through direct contact with the blood and/or secretions of an infected person) sets in motion alarm and panic within a populus. Caring for the sick becomes a true test of altruism. Whole families can become infected when they are caring for a sick relative. With this recent outbreak, 9 of the 16 deaths have occurred in a single household.

Evidently the way the virus kills captures the imagination — a virus that turns your internal organs into soup, resulting in you bleeding through every orifice. But outside of that, the fact still remains that there is still no cure, and with every outbreak the first to respond will be the ones at the most risk. And in resource-poor settings without running water, and hospitals without the basics, the risks are very high.

In 1976 in Sudan, during the first ever recorded outbreak of the virus, 61 out of the 154 nursing staff at the hospital caught the virus — of whom 33 died.

In 1995, an outbreak in Zaire resulted in health workers making up a quarter of the 315 confirmed cases.

In the ninth week of the 2001 outbreak, the man who first alerted the ministry of health to the outbreak, a medical superintendent at the hospital, died from the virus.

In 2007, after a late-confirmed outbreak of the virus, nurse Kiiza Isaac caught and survived a bout of Ebola.

This year, of the deceased one was a clinical officer who caught the virus after attending to a patient and her 4 month-old infant.

Undoubtedly, there are many more individual stories of those that were caring for the sick succumbing to the virus. This is the virus’ most pronounced footprint it seems. Added to the image of death it conjures up, the fear of catching it is multiplied. And that is what it does to a population. Every time ebola strikes, fear manifests as panic.

Reaction of the threat of Ebola spills out in many different ways. During the 2001 outbreak, a suspicious death of a man in hospital in Kampala set-off a literal stampede where health workers and patients fled from the scene.

A man in Iganga — 400 km away from the nearest confirmed case — barricaded himself and all his family inside their house with supplies of food and water in an attempt to last-out the outbreak.

Banks clerks wore gloves when handling money for fear of the virus.

Pickpockets suddenly became more hesitant to relieve travellers of their belongings.

Despite the panic from the local population whenever Ebola strikes, it is the reassurance of direct patient care from the multitude international organizations that puts people at ease. Since the outbreak was reported the Ugandan ministry of health has worked with the WHO, CDC, Red Cross, MSF, World Vision, and PREDICT to control the outbreak of the virus.

“Technically, responding to an Ebola outbreak is not that complex, but people are reassured when an organisation with expertise is there. Once MSF comes and sets up the isolation unit, you see that people start thinking, well this is something we can manage.”

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Originally appearing in Australian Science Magazine

ResearchBlogging.org

[No authors listed] (1978). Ebola haemorrhagic fever in Sudan, 1976. Report of a WHO/International Study Team. Bulletin of the World Health Organization, 56 (2), 247-70 PMID: 307455

Kinsman J (2012). “A time of fear”: local, national, and international responses to a large Ebola outbreak in Uganda. Globalization and health, 8 (1) PMID: 22695277

Gonzalez JP, Pourrut X, & Leroy E (2007). Ebolavirus and other filoviruses. Current topics in microbiology and immunology, 315, 363-87 PMID: 17848072

Pourrut X, Kumulungui B, Wittmann T, Moussavou G, Délicat A, Yaba P, Nkoghe D, Gonzalez JP, & Leroy EM (2005). The natural history of Ebola virus in Africa. Microbes and infection / Institut Pasteur, 7 (7-8), 1005-14 PMID: 16002313

How we write about global health…

 

PJ Hotez writing in the New York Times

These are, most likely, the most important diseases you’ve never heard of. They disproportionately affect Americans living in poverty, and especially minorities, including up to 2.8 million African-Americans with toxocariasis and 300,000 or more people, mostly Hispanic Americans, with Chagas disease. The neglected tropical diseases thrive in the poorer South’s warm climate, especially in areas where people live in dilapidated housing or can’t afford air-conditioning and sleep with the windows open to disease-transmitting insects. They thrive wherever there is poor street drainage, plumbing, sanitation and garbage collection, and in areas with neglected swimming pools.

PJ Hotez. His name has somewhat become synonymous with neglected tropical diseases, being not only a researcher but also a leading advocate for the diseases we never hear about and never give many column inches to.

Global health topics — the broccoli of all science news — rarely get the attention they deserve so it’s nice to see it in the NY Times. More importantly, the way we write about global health all too often comes from the same place. An article on global health will always portray the gravity of the situation with numbers. How many people a year are affected by the disease. Some diseases come with that, for lack of a better term,  killer-stat — “every 30 seconds a child dies of malaria”. The stats are there for a reason.

An article on global health might start with the plight of the individual.

Twelve-year-old Sunday Oderinde sits by the side of the road with both legs folded under him and watches his friends play a game of soccer on the streets of Iwaya, a suburb in Lagos, Nigeria. It is a game that he would love to join in but cannot.Oderinde contracted polio as a child. Though 90 percent of polio infections cause no symptoms at all, Oderinde’s limbs were paralysed. Now he can only walk with the help of crutches, which he keeps by his side as he watches as the game plays out on a makeshift football pitch.

A global health article might also seek to employ hyperbole. PJ Hotez certainly has done on occassion. Coming under criticism for it aswell. The hyperbole is there for a reason.

But Dr. Peter Hotez, dean of Baylor College of Medicine’s National School of Tropical Medicine, said he penned the provocative editorial to rally resources for people with Chagas disease. “I wanted to call attention to the disease; make people aware of it,” said Hotez, adding he had no intention to diminish the impact of HIV/AIDS. “I believe that Chagas disease is every bit as important as the AIDS problem, but no one’s ever heard of the disease.”

Therein lies the shared confession.

To be honest, this is more of a half-observation than an all-encompassing critique in the vain of “How Not to Write About Africa“. Perhaps the trouble in the way we write about global health is that it stems from the fact that all too often global health is intrinsically tied to the world of aid and development. Anytime we seek to write about the world’s “bottom billion” a part of us is looking for the reader to be compelled to do something about it. “Rally resources” is another way of saying advocacy. Given the fact that little funding at every stage is put aside for global health (unless you happen to be Melinda Gates), then that advocacy component will no doubt remain.

 

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Sports, race, and the taboo…

Moments before Jamaica’s 1, 2, 3 in the Men’s 200m final, the BBC ran a segment on race, genetics, and the taboo that is the fact that black athletes dominate athletics.

“Only one white sprinter has ran under 10 secs…”

The segment itself lasted little more than 5 mins, and in the grand tradition of the Beeb it was balanced, erring on the side of simplistic. They score points for being bold and highlighting a topic that can be contentious. But the science they depicted in it, obviously for such a short segment, didn’t portray the full story — and came off as slightly sinister (with eugenics as the topic perhaps that was unavoidable).

For a topic like this it would be hard not to cite Darwin. Indeed, producers at the Beeb mentioned “survivial of the fittest” right out of the gate. And in this context perhaps a phrase that could end up being confusing from its original metaphorical meaning.

It’s hard to tell what sort of reaction the segment caused. Twitter is never a good barometer for things like these. Equal parts moral indignation and support.

All the elite athletes can trace their ancestry back to West Africa… that is, back to slaves, said the BBC segment. But how true is that?

The Daily Beast have an article on the same subject… going further into the taboo and not just looking at elite athletes over short distances. The piece itself is much more nuanced. Ending with the overrall sense that there are no easy answers to this. No matter how clear the genetics and science of population genetics seem, it is never truly the whole story.

It’s in their culture, say many social scientists. Kenyans dominate distance races because they “naturally trained” as children—by running back and forth to school, for example. “That’s just silly,” Kenyan-born Wilson Kipketer told me. Kipketer currently holds eight of the 17 all-time fastest 800m times, a middle-distance track event. “I lived right next door to school,” he laughed, dismissing cookie-cutter explanations. “I walked, nice and slow.”

The “nurture versus nature” debate will no doubt continue, and hopefully with a lot less taboo.

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