Tom Yates from University College London reviews Peter Gøtzsche’s recent book about the pharmaceutical industry.
Image credit: Sage Ross, Flickr
I have long been concerned about the conduct of drug companies. I worry about pervasive conflict of interest in the generation, synthesis and dissemination of the evidence that guides my clinical practice. So, when I was asked to review Peter Gøtzsche’s book on these topics, I was excited.
It is hard to imagine someone better qualified to write this book: a biology and chemistry graduate, Peter Gøtzsche began his career as a sales rep for Astra. In 1977, he took responsibility for setting up a medical department at Astra-Syntex and saw from the inside how trials can be abused to build a case for particular products – in his case Naproxen, a non steroidal anti-inflammatory drug (NSAID). In 1978 he started medical school, whilst still working for the company, only leaving Astra-Syntex on qualification six years later.
Gøtzsche’s PhD focussed on bias in randomised controlled trials of NSAIDs for rheumatoid arthritis, generating important results regarding the impact of funding on outcome. He went on to help found the Cochrane Collaboration and to found the Nordic Cochrane Centre. His academic career has focussed on bias, trials and evidence synthesis.
Tane Luna Ramirez from Médecins Sans Frontières reflects on the challenges of providing care for pregnant women as well as the heightened risk of sexual violence in disaster settings.
MSF is the main health care provider in Domeez refugee camp, Iraq, where more than 55,000 people, most from Syria, have settled.
Photo credit: Pierre-Yves Bernard/MSF
Today, as International Women’s Day approaches, up to 23,000 people will be forced to flee their homes, joining 45 million others around the world who are already displaced due to conflict, persecution, or natural disaster. Of course people of both sexes suffer and die from the direct consequences of these displacements, and from the crises that cause them. But women are especially vulnerable. For those who are pregnant, lack of care may be their biggest threat to survival. And especially in contexts of conflict, women and girls face a hugely increased risk of sexual assault.
The group of 20 (G20) finance ministers meeting in Australia has just announced an ambitious initiative to boost the world’s gross domestic product (GDP) by at least $2 trillion over the next five years. To achieve this target they propose to shape and implement new policies that increase investment and employment, and promote competition and trade.
So far there has been no mention of health as a means to promote economic development among the G20 nations, even though we learned more than a decade ago from the World Health Organization’s Report of the Commission on Macroeconomics and Health led by Jeffrey Sachs that diseases can actually cause poverty. Such findings provided the basis for which disease targets were added to the Millennium Development Goals.
In an analysis published last year in PLOS NTDs I found a surprising number of neglected tropical diseases (NTDs) – a group of 17 major chronic, debilitating, and mostly parasitic infections – among the poor living in G20 countries. Indeed most of the world’s cases of the worst NTDs (as measured in disability-adjusted life years) including Chagas disease, food-borne trematodiases, leishmaniasis, leprosy, lymphatic filariasis can be found G20 countries (together with Nigeria), as well as almost one-half of the hookworm cases. Based on additional new data coming out of Oxford University, many of the world’s dengue fever cases are also among the G20. So with the exception of a few NTDs such as African trypanosomiasis, onchocerciasis, and schistosomiasis, which are overwhelmingly sub-Saharan African diseases, the NTDs are mostly G20 problems. This includes the United States where I have found widespread NTDs in the midst of southern poverty.
The poor living among the wealthy. Major areas of poverty in the G20 nations and Nigeria, where most of the world’s NTDs occur (map prepared by Esther Inman). Figure from Hotez PJ (2013) NTDs V.2.0: “Blue Marble Health”—Neglected Tropical Disease Control and Elimination in a Shifting Health Policy Landscape. PLoS Negl Trop Dis 7(11): e2570. doi:10.1371/journal.pntd.0002570
Sara Gorman from Columbia University discusses viral load testing in resource-poor settings
Image Credit: David_Jones, Flickr
In July of 2013, the World Health Organization (WHO) released new guidelines on antiretroviral therapy. Among the most significant new recommendations include: initiating ART earlier, in all individuals with a CD4 count of 500 per mm3 or less; starting ART at any CD4 count in particular populations, including pregnant and breastfeeding women and children under 5 years of age; and the use of viral load testing as the preferred method of monitoring response to ART and detecting treatment failure. Viral load measurement is already the method of choice for detecting treatment failure in high-income countries. But the recommendation has never included reliance on viral load measurement because middle- and low-income countries do not have the same access to the tools needed to measure viral load that high-income countries do. This raises an important question: are the new WHO recommendations realistic for low-income countries? If not, what needs to be done to achieve better access to technologies for viral load monitoring in resource-poor settings?
Viral load monitoring is often of critical importance to managing patients with HIV who take antiretrovirals. Viral replication in a patient taking ART can give rise to drug-resistant mutations as well as treatment failure. In addition, alternative drugs must be available in cases of treatment failure. If they are not, viral load testing to determine treatment failure is not useful.
PLOS Currents: Outbreaks issues a call for papers in collaboration with the European Centre for Disease Prevention and Control (ECDC) on the issue of vaccine hesitancy.
The prevention of outbreaks of vaccine-preventable diseases, such as measles, rubella, or polio, is dependent on herd immunity. Yet ensuring widespread vaccination coverage is complicated by a wide range of factors, not least vaccine hesitancy, through which segments of the public are uncertain about the safety and efficacy of vaccinations.
In May 2013 the ECDC hosted a multi-disciplinary scoping meeting to address the issue of vaccine hesitancy. Participants came from the fields of psychology, anthropology, epidemiology and medicine to discuss trends in the public acceptance of vaccines, with the following objectives:
• to explore the key drivers behind recent trends in measles epidemiology and vaccination coverage in Europe
• to identify and conceptualize the myriad social and political factors that affect individual decision-making as concerns vaccination
• to identify and examine best practices in public health for monitoring and addressing public mistrust in vaccines
• to identify potential ECDC activities in this field
Manica Balasegaram from the Médecins Sans Frontières (MSF) Access Campaign, reflects on a research and development system that is failing the world’s poorest people.
Image Credit: e-MagazineArt.com, Flickr
The past month has seen the reputation of Big Pharma dented more than usual. The CEO of German pharmaceutical company Bayer, Marijn Dekkers, was reported as saying that the company didn’t develop a cancer drug for the Indian market, but rather “for Western patients who can afford it”. The comment summed up the attitude of the pharmaceutical companies towards the poor and succinctly described what is wrong with today’s research and development (R&D) system.
In a similar vein, last month British/Swedish pharma company AstraZeneca announced it was pulling out of all early-stage R&D for malaria, tuberculosis (TB) and neglected tropical diseases – all diseases of the developing world. Instead, the company stated they will focus efforts on drugs for cancer, diabetes and high blood pressure, all diseases that affect rich countries, with potentially plenty of people to pay the high prices on new drugs.
James Ridgeway, from Solitary Watch, asks whether the health needs of American prisoners are being neglected.
Image credit: Jumilla at Flickr
There are 2.3 million people in US prisons in conditions that are often inhumane and at worst life threatening. An estimated 80,000 of US prisoners are locked up in solitary confinement, which means in a 6 ft x 9 ft cell containing little more than a bunk bed, toilet, sink, shelf, and unmovable stool. Prisoners in solitary confinement are let out in leg irons, handcuffs and belly chains for ‘exercise’ two or three times a week in dog kennel-type runs. Bathing is sporadic and the food often miserable and insufficient. One third of prisoners in solitary confinement are thought to be mentally ill and half are placed in solitary for nonviolent crimes.
Recently, the press has begun suggesting the situation in US prisons might be improving slightly.
Peter Hotez and colleagues from Baylor College of Medicine highlight the mystery of Mesoamerican nephropathy which is killing young men in Central America.
Image Credit: Zeetz Jones, Flickr
Over the last decade drug trafficking and violence have taken the lives of thousands of people, most of them young men, in Guatemala, Honduras, and elsewhere in Central America. Far less known is Central America’s hidden killer disease that has recently been named Mesoamerican nephropathy. Mesoamerican nephropathy appears to be an emerging form of chronic kidney disease of unknown etiology that disproportionately strikes young male agricultural workers primarily in the Pacific coastal regions of El Salvador and Nicaragua, but also in Guatemala and Costa Rica. According to Correa-Rotter et al the syndrome was first described in 2002 as a form of advanced chronic kidney disease at the Rosales Hospital, a referral hospital in the capital of El Salvador, which developed without the usual chronic risk factors such as diabetes and hypertension. Among its most common features, Mesoamerican nephropathy typically presents as a progressive tubulointerstitial form of renal disease and failure with no or low grade proteinuria. The histopathology findings from renal biopsies are unique and different from other causes of renal disease. It most commonly affects young men working in sugarcane plantations along the lowland Pacific Coast of Central America. Because this part of Central America is a resource poor area, those affected often die prematurely due to inadequate access to renal dialysis.
PLOS Medicine and the MHTF review highlights of the second successful collection, as part of their 3 Year partnership focusing on improving Maternal Health globally.
Back in late 2012 the Maternal Health Task Force, at the Harvard School of Public Health, and PLOS Medicine issued a call for papers on the theme ‘Maternal Health is Women’s Health’, chosen in order to recognise that a women’s health is of crucial importance through her lifetime, and not just during pregnancy and labour.
Image Credit: Jack Zalium and Richard Basset
The breadth of the research that has been submitted to PLOS since the call has been of great quality and impact. In this blog, we’d like to highlight just some articles in the collection that represent a selection of the important work recommended to alleviate the poor health, low educational attainment and low socioeconomic status adversities affecting maternal health, that women and girls of experience throughout their lifetimes.