Carriage Trade

Advances in treatment need not go hand in hand with advances in cost.

Left Field by Patricia Nell Warren

One disgrace of current biomedical research is the persistent development of treatments and cures that only benefit the wealthy because they are so expensive. We hear endless rhetoric about research that will supposedly benefit the vast mass of people on the planet, most of them living in poverty. Supposedly it’s urgent to alleviate their suffering from every infirmity and contagious disease known to humanity. I could give a number of examples. But many of the discoveries—the new drugs, even the daring and dramatic operations that you see on TV, that save a single life in the glare of spotlights—are simply not affordable by most people.

Let’s look at one of the most glaring examples of carriage-trade treatment. Malaria is an ancient disease that kills an estimated 1 million people a year in a broad belt around the globe—tropical and subtropical areas where mosquitoes carrying this parasite can be found. The disease is caused by the proliferation of tiny Plasmodium parasites in the blood. The parasites are injected into the human body through bites by infected Anopheles mosquitoes. Historically alleviated in the West with an extract of quinine bark, malaria was treated more recently with a drug called chloroquine. But in recent years, many strains of falciparum malaria, the most lethal variety, have built up a fierce resistance to chloroquine, especially in Africa.

In his recent book Federal Bodysnatchers and the New Guinea Virus, epidemiologist Robert S. Desowitz tells the story of how the new malaria curative Riamet was developed by Chinese researchers from an extract of artemisia plants. The drug was later licensed by Novartis and patented in Europe, where it was sold at $57 a treatment-sized bottle. Reportedly Riamet cures over ninety-five percent of cases of falciparum malaria. Desowitz commented, “There was no altruistic intention to give, literally ‘give,’ Riamet to the malarious millions in Africa and other endemic developing regions. Novartis and its Chinese partners expected big profits from sales to tourists and other rich, mostly white, Europeans who dare venture where the anopheline flies.” Here in the U.S., Riamet was never FDA-approved, but Americans going abroad into malaria country can purchase foreign-made supplies on-line—if they can afford it. At a cost of anywhere from $100 to $286 for a bottle of twenty-four, this daddy of current anti-malarials is strictly for the carriage trade.

Not surprisingly, the diamond-studded debut of Riamet was greeted by cries of outrage from governments of cash-strapped debt-ridden developing countries, especially in sub-Saharan Africa, where most malaria deaths occur. After a flurry of lobbying, the World Health Organization created a Roll Back Malaria program. In 2001, Novartis agreed to sell Riamet in Africa for $2 a treatment—which they insisted was their not-a-penny-less price. So thousands of Africans are still not getting access to this upgraded malaria treatment. Instead they’re getting chloroquine, which is cheap (twenty cents a treatment) but seldom effective because of widespread resistance.

When it comes to AIDS, the latest addition to carriage-trade treatment may be the widely publicized “cure”—said to be the first in history—of an HIV-positive person. In Berlin, Germany, Timothy Ray Brown was being treated for two diseases—leukemia (with chemotherapy) and HIV (with standard ARV treatments). Leukemia treatment involves killing off the cancerous blood cells with chemo, then replacing them with healthy new cells stimulated by infusions of stem cells from a donor match. Brown’s doctor, Gero Hütter, MD, came up with the bright idea of a double-barreled treatment—stem cells carrying the inherited CCR5 delta 32 gene that confers resistance to HIV. This gene is found in some northern Europeans. After an exhaustive search, Hütter finally found a stem-cell donor who was a match for Brown, as well as a carrier of CCR5 delta 32. Eventually the stem cells did their job. Brown’s leukemia went into remission, and his HIV viral load went “undetectable.” Over three years later, Brown is still reportedly free of the virus.

Few of the world’s media could resist this story of a seemingly miraculous cure—it has been making the rounds for weeks, from the wire services to medical publications online. According to Daniel J. DeNoon in a WebMD feature: “Few people with HIV would want to go through the grueling and life-threatening cancer treatment that was part of this cure. And so far, the cure has not been duplicated in other HIV-positive leukemia patients who underwent similar treatment. Yet the finding already has transformed AIDS research.”

Yet the cost may make the “Berlin patient MO” unavailable to all but the wealthiest HIV-positives. Not to mention the difficulty of finding a donor match for each and every person with HIV. Brown’s treatment, which took place over a number of years, including follow-up, may have run into multiple digits. In spite of these daunting prospects, the NIH is now reportedly rushing to pour major research funds into this stem-cell approach.
How sad that the carriage trade is such a dominant force in medical research today. As long ago as 2004, several authors in The Lancet lashed into what they called the “medical malpractice” behind profit-oriented malaria research. They said, “We need to change the approach from ‘access to drugs’ to ‘access to care.’” That criticism, launched seven years ago, can be aimed at AIDS care as well.

Author of fiction bestsellers and provocative commentary, Patricia Nell Warren has her writings archived at Reach her by e-mail at [email protected].

Copyright © 2011 by Patricia Nell Warren. All rights reserved.

July 2011