if I had some remedy, I'd take enough to please me

Since I will otherwise spend this time complaining about the last-minute cancellation of my dental appointment (and who in the world wants to read about that?), let me turn my attention to a real problem that seems difficult to solve. For a long time now, malaria has continued to plague the developing world, and, unsurprisingly, not much funding has been provided to search for better therapies. Sadly, like most parasitic diseases, this impacts the young the most, and leads to well over a million deaths a year in children. Saheli e-mailed me some time back about artemesinin, a new antimalarial that was isolated from sweet wormwood.

The problem with malaria, and many infectious diseases, is always resistance. Anyone who has had strep throat gets the lecture from their physician about taking all of their penicillin, amoxicillin, or whatever is now used to treat strep. This is because it is critical to wipe out the entire bug without a trace from your system. Bacteria, viruses, parasites- all seem to have an incredible sense of self-preservation. Would that we all had their sense of resilience. Most of their power is derived from their ability to evolve at a fast rate, in a sense. As they are rapidly multiplying, they have an increased opportunity to mutate into resistant strains. So, indeed, they do. There are now strains of Staph bacteria that are resistant to vancomycin, which was developed specifically for treating antibiotic-resistant bacteria.

It's daunting, because it is inevitable. In a fight of humans vs. bugs, the bugs are designed to win without the intervention of outside forces. Artemesinin is one such outside force, but treatment quickly gets complicated. In order for artemesinin to be most effective, the WHO and the medical community agree that the drug should be part of a cocktail of antimalarial drugs. Using cocktails on HIV and malaria and other infectious diseases all stem from the same war strategy of all-out assault, leaving little to no chance for survivors seeking revenge.

But here's where the problems really start to emerge. The NYT reports that 18 pharmaceutical companies have been warned by the WHO malaria chief that they should stop selling artemesinin in its solo (or monotherapy) form. These companies sell the pill by itself instead of in a cocktail, and these pills then find their way to markets where people can purchase and take the medication if they are worried about malaria. This is a huge problem, because it is a quick route to developing a resistant strain to artemesinin. Don't take my word for it. Check out how strongly the chief, Dr. Kochi, frames the situation:

“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.”

But how do you control the companies? Some of the companies, like Sanofi-Aventis, have reacted positively to the warning, and have indicated that they will phase out the monotherapy version of artemesinin. On the other hand, some of the companies are not being as cooperative. For example, Indian pharmaceutical giant, Cipla basically scoffed at the warning. As you can hear in the NPR piece, Cipla does not consider this problem their problem.

And that is the trouble. The WHO chief issued some strong threats, but is fairly powerless at really controlling the companies in this situation. And who should be responsible for making sure that these drugs are administered correctly? The pharmaceutical companies place the accountability on physicians. That is a little weak, in my opinion, because some of these companies are getting drugs into places where prescriptions won't be necessary, making physician involvement in administration pretty non-existent. But, on the other hand, I think it's silly to rely on companies to simply do the right thing, especially at a time when what is right is always considered a matter of opinion. It seems something that governments have to band together to tackle. The chances of that actually happening are slim.

Count on me to really liven things up on a Friday. I will make it up to you if you are in the Bay Area- come to a party to celebrate maisnon's birthday tomorrow.