Altruism vs Profitability: How do we get our drugs to where they are

needed?

Why did I choose this topic?

Universities Allied for Essential Medicines

Elephantiasis (form of

Lymphatic Filiariasis)

Leprosy

http://www.medicalook.com/diseases_images/leprosy.jpg www.healthcaremagic.com/articles/Elephantitis-Lymphatic-Filariasis-elephantiasis/2516http://essentialmedicine.org/

Perspectives I will explore

Altruism? vs Profitability?

Inequitable access to essential medicines

(2000-2003) Access to essential drugs has grown but inadequate financing and poor health care delivery are still constraining

factorsRef: http://apps.who.int/medicinedocs/en/d/Jwhozip16e/8.2.html

What is an essential medicine?

“The inequities are striking. In developed countries, one-year’s treatment for HIV infection consumes the equivalent of four to six months’ salary. And the majority of drug costs are reimbursed. In many countries one-year’s HIV treatment - if it were purchased - would consume 30 years’ income. And the majority of households must buy their medicines with money from their own pockets.”WHO Press Release WHA/13, 22 May 1999 (2)

The WHO defines essential medicines as medicines which are:• intended to satisfy priority health

care needs• selected with relevance to public

health• selected with evidence to efficacy,

safety and cost effectiveness• intended to be available at all times• affordable to the community’

Lack of research for neglected diseases:

Proportion of New Chemical Entities approved from 1975 to 1999The tropical diseases here refer to parasitic diseases of Malaria, African trypanosomiasis,

Chagas’ disease, schistosomiasis, intestinal nematode infections, plus leprosy, dengue, Japanese encephalitis, trachoma and infectious diarrhoeal diseases.

Ref: Trouiller P et al Drug Development for neglected diseases: a deficient market and a public health policy failure. The Lancet Vol 359 2002 :Data from IMS Health Drug Monitor 1999 (http://www.imshealth.com); EMEA and FDA data

15.10%

12.80%

8.00%

6.40%16.10%

1.90%0.20%

0.90%

0.30%

41.60%

Central Nervous System

Cardiovascular

Cytostatics (neoplasms)

Respiratory (non-infectious)

Anti-infectives & antipar-asitics

HIV/AIDS

Tuberculosis

Tropical diseases

Malaria

Other therapeutic categories

“90% of global expenditure on medical research is on diseases causing 10% of

the global burden of disease”

Ref: Solomon, R., Benatar, Abdallah, S. Daar & Peter A. Singer (2003) Global Health ethics: the rationale for mutual caring. International affairs 79, I 107-138

Social JusticeEquityEquality

InnovationTransnational flowsGlobalisationInterdependence

HealthPoverty

Global Citizenship: Focal areas

Proactivity concerning

environmental

sustainability

AstraZeneca Representative

Why has it been so difficult for these big companies with so much power and so many

resources at their disposal to be more altruistic? The answer: profit is incentive, altruism not so

much.

“Chasing profits does not deliver most people the goods they need at a price they can afford, and so the market is much smaller than it could be: a CEO who doesn’t deliver won’t last long.” *

“Several former pharmacutical CEOs have criticised the research climate after stepping down, while other leading researchers have moved to academia, where they can explore innovative science free from the constraints of profitability.” *

Ref:*Philip Ball (2010): Making a better world. Prospects magazine – issue 175

UAEM‘Our drugs. Our

labs. Our responsibility.’

Ref: http://essentialmedicine.org/about-us

Ref: http://uaemedinburgh.files.wordpress.com/2009/01/uaem_efisher01.jpg?w=667&h=450

What have the students done so far?

2001 2006 2010

(1) Kishore S P, Maciag K. (2010) Generic drugs for developing nations. Nature Reviews. Microbiology

(2) http://essentialmedicine.org/our-work/successes(3) The Ticker: 5 universities to use licensing to provide cheaper drugs

to poor and developing world. The Chronicle of Higher Education 2009

What has the ‘Big Pharma’ done so far?

-Due to make 13,500 compounds from its malaria screening programme available to the public- Has promised $8million to provide researchers to investigate these compounds-Has donated over 1 billion doses of albendazole towards eradication of lymphatic filiarisis

- Pledged to give Mectizan (ivermectin = drug for river blindness) free of charge until disease is eradicated

- Donated azithromycin for treatment of glaucoma

-Provides drug Truvada (combination of tenofovir and emtricitabine = 2 of the antiretrovirals) at prices reflecting a country’s economic status

Ref = Editorial: A Step in the Right Direction (2010) Volume 8. P244 www.nature.com/reviews/micro

The Bill & Melinda Gates Foundation

Has donated:

• over $287million to HIV/AIDS research (1)

•Over $280million to the Global TB Vaccine Foundation (2)

• Over $5million to visceral leishmaniasis research (3)

(1) "Gates gives $287m to HIV research". BBC News. 2006-07-20.http://news.bbc.co.uk/1/hi/world/americas/5197082.stm(2) Nightingale, Katherine (2007-09-19)"Gates foundation gives US$280 million to fight TB”

http://www.scidev.net/en/news/gates-foundation-gives-us280-million-to-fight-tb.html (3) ($5m for disease control in Ethiopia in Israel 21c Innovation News Service. http://www.israel21c.org/briefs/5-m-for-disease-control-in-ethiopia

So what does this mean to me?My reflections as a medical student:

• I remain an altruistic medical student

• I have more understanding of the reasons behind incentive for research

• It may be so that recent pressure has forced pharmaceutical companies to take some kind of action. However we must not become apathetic as there is still an important access gap and neglected disease research drought.

• I am reassured by the action of organizations including the Gates Foundation and the universities, and I urge other medical students to have a look at the UAEM

• I now aim to take my global health learning and engagement further.

• I do not want to be just a part of English medicine; I want to be a part of world medicine

Thank you for listening!