Saturday, October 31, 2009

Swine flu, leptospirosis and new medicines

New and evolving diseases require new and evolving drugs and other medical treatment to prevent such diseases from spreading. The emergence of new environmental problems like prolonged flooding of low-lying areas exacerbates some diseases that were just minor problems in the past, but have become major diseases recently.

In the US, swine flu has killed more than 1,000 people this year, and up to 5.7 million may have been infected in its first few months of outbreak, according to the US Center for Disease Control (CDC). And the current strain may not be the same that was discovered in late April this. US President Obama has already declared swine flu a national emergency, noting that "the pandemic keeps evolving". With such a big number of deaths, this is indeed a troubling disease. The US government has ordered some 150 million vaccines, mainly Tamiflu made by Roche, by December.

Here in the Philippines, there is a leptospirosis outbreak in some areas of Metro Manila and a few other provinces that remain flooded until now, more than a month after severe flooding that occurred last September 26. As of today, nearly 2,200 people have been infected while 167 have already died from the disease. The spread of the disease has been faster over the past few days.

The Department of Health (DOH) is prescribing only one medicine so far, the anti-biotic doxycycline. The agency notes that this medicine is not 100 percent effective, it can only give some protection to infected persons. Besides, in the guidelines it has issued in using this prophylaxis, it notes several precautions. The medicine for instance, can NOT be given to the following people: pregnant women, women breastfeeding their babies, children below 8 years old. Physician’s caution should also be taken if one has liver or kidney disease, and the drug can cause allergy, diarrhea and/or other side effects like esophageal damage. See the list of precautions about doxycycline at

With a rather long list of precautions and prohibitions in the use of the only medicine being prescribed by the DOH to fight leptospirosis, infected patients and their loved ones will only wish that there are other alternative medicines. But what and where are they?

I have noted in my earlier articles before in this column: people's lifestyle evolve, communities evolve, diseases evolve, and so medicines and other medical treatment must also evolve. This requires endless research and innovation, endless invention of new and more powerful medicines not only for old and known diseases, but also for unseen and unknown diseases. Medicine and pharmaceutical research, therefore, should be encouraged, not discouraged.

If more profit for the successful research companies is the main incentive to encourage more companies and scientists to go into this kind of work, then society should give it to them. After all, not all pharmaceutical researches are successful and useful. Majority of such researches are unsuccessful and punched big losses for the companies that undertook those research.

What is important is that more effective medicines for more killer diseases should be invented and be made available to the public. There should be several medicines from more competing companies for each killer disease, so that patients and their physicians can have more choices for the specific needs and health/economic conditions of patients. Cost or the price of medicine, though an important consideration, therefore, becomes a secondary issue. The primary issue is the availability of more medicines for more various diseases.

Some rich people are willing to become poor just to save or prolong the life of a loved one. And in many cases, money is not the issue or the solution. It is the non-availability of more powerful drugs and vaccines that can save people from killer and ever-evolving diseases. So for some people, they may have all the money in the world but if the drugs that can cure their loved ones are not there, then early death will be certain.

Unfortunately, for many countries in the world including the Philippines, pricing and intellectual property rights (IPR) of medicines have been heavily politicized. Many politicians and the activist public do not ask about more competition in medicines and medicine producers. They ask for quick political fixes to non-political problems like evolving diseases. And this is where long-term problems will crop up someday. The short-term gains of cheaper medicines -- via price control, via patent confiscation like compulsory licensing and “early working” on still patented drugs -- will be defeated by the long-term loss or non-availability of new medicines that will be brought into the market.

It is indeed ironic that the public, the politicians and would-be politicians did not listen to the majority of the sectors – multinational and local pharma companies, hospitals, drugstores, physicians, pharmacists, and a few NGOs – that opposed drug price control policy. And this points to one ugly reality of politics: problems or issues that could be addressed with zero politics have become heavily politicized. For health issues for instance, politicians and the activist media or NGOs who do not produce even a single medicine dictate the policies for medicine innovation and pricing.

The Senator who has pushed hard the issuance of drug price control policy is no longer running for President. It is notable to mention perhaps, that while there were Committee meetings and public hearing on drug price control every 3 weeks on average while he was still a declared Presidential candidate, there have been zero Committee meeting since the time he abandoned the plan two months ago.

With the spread of both old and new diseases, or new strains of old diseases, the importance of encouraging endless research and production of more innovative and more powerful drugs is highlighted. Let us hope that harsh political interventions like price control and patent confiscation that discourage such innovation, will not be imposed easily and frequently.

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