Re: GEN: Herbal Drug Widely Embraced in Treating Resistant Malaria
From: art fougner, md (evsono@pipeline.com)
Mon May 10 18:20:22 2004
An interesting review can be found on the Doctors Without Borders
(Medecins Sans Frontieres ) website.
http://www.msf.org/content/page.cfm?articleid=2F169856-4D66-4E90-B49E02C3EAE4F496.
El - do you have any experience with this?
art
At Mon, 10 May 2004, art fougner, md wrote:
>
>Herbal Drug Widely Embraced in Treating Resistant Malaria
>By DONALD G. McNEIL Jr.
>
>After years of hesitation, world health agencies are racing to acquire
>100 million doses of a Chinese herbal drug that has proved strikingly
>effective against malaria, one of the leading killers of the poor.
>
>The drug, artemisinin (pronounced are-TEM-is-in-in), is a compound based
>on qinghaosu, or sweet wormwood. First isolated in 1965 by Chinese
>military researchers, it cut the death rate by 97 percent in a malaria
>epidemic in Vietnam in the early 1990's.
>
>It is rapidly replacing quinine derivatives and later drugs against
>which the disease has evolved into resistant strains.
>
>To protect artemisinin from the same fate, it will be given as part of
>multidrug cocktails.
>
>Until recently, big donors like the United States and Britain had
>opposed its use on a wide scale, saying it was too expensive, had not
>been tested enough on children and was not needed in areas where other
>malaria drugs still worked.
>
>Unicef, the United Nations Children's Fund, which procures drugs for the
>world's poorest countries, opposed its use during an Ethiopian epidemic
>last year, saying that there was too little supply and that switching
>drugs in mid-outbreak would cause confusion.
>
>But now almost all donors, Unicef and the World Bank have embraced the
>drug. The new Global Fund for AIDS, Tuberculosis and Malaria has given
>11 countries grants to buy artemisinin and has instructed 34 others to
>drop requests for two older drugs — chloroquine and
>sulfadoxine-pyrimethamine — and switch to the new one.
>
>"We want countries to move very rapidly to use it as a first-line
>treatment," said Dr. Vinand Nantulya, the fund's malaria adviser. The
>fund expects to spend $450 million on the drug over the next five years,
>he said.
>
>The World Health Organization, a United Nations agency based in Geneva,
>estimates that 100 million doses will be needed by late 2005.
>
>Malaria causes about 300 million illnesses a year, and at least 1
>million deaths, 90 percent of them in Africa and most of them children
>under 5. Despite more than a century of eradication efforts, the
>disease is endemic from the Mekong Delta in Vietnam to the Amazon Basin
>in Brazil, and is particularly severe across central Africa, from the
>cane fields of Mozambique to the oases of Somalia to the rubber
>plantations of Liberia.
>
>Like many tropical disease drugs, artemisinin is a fruit of military
>research. Chinese scientists first isolated it in 1965 while seeking a
>new antimalarial treatment for Vietnamese troops fighting American
>forces, said Dr. Nelson Tan, medical director of Holley
>Pharmaceuticals, which makes the drug in Chongqing, China.
>
>Another antimalarial drug still in use, mefloquine, was isolated at the
>Walter Reed Army Institute of Research in 1963 for American troops in
>the same jungles. Under the name Lariam, it is still issued to troops
>and sold to travelers.
>
>Artemisinin, which has no significant side effects, quickly reduces
>fevers and rapidly lowers blood-parasite levels, which can keep small
>outbreaks in mosquito-infested areas from becoming epidemics.
>
>Two years ago, Dr. Dennis Carroll, a health adviser to the United
>States Agency for International Development, said artemisinin was "not
>ready for prime time." But on April 30 at a malaria conference at the
>Columbia University School of Public Health, he led a session on ways to
>induce farmers to plant more wormwood.
>
>Dr. Carroll said that more evidence had emerged that the drug was safe
>and that older drugs were not working. Also, the creation of the Global
>Fund expedited grants for it.
>
>Dr. Stewart Tyson, a health expert with the British Department for
>International Development, said his agency changed its opinion about the
>drug after its experience in Uganda, where resistance to older drugs had
>climbed to 31 percent in some areas in 2003 from 6 percent in 2000.
>
>The price of artemisinin cocktails has fallen from $2 per treatment to
>90 cents or less as more companies in China, India and Vietnam have
>begun making them. (Older drugs cost only 20 cents.) Novartis, the
>Swiss drug giant, sells its artemisinin-lumefantrine mix, Coartem, to
>poor countries for 10 cents less than it costs to make, a company
>official said. The same drug, under the name Riamet, is sold to
>European travelers for about $20.
>
>As a plant material, artemisinin cannot be patented, said Dr. Allan
>Schapira, a policy specialist for the Roll Back Malaria campaign of the
>World Health Organization. Nor can the simple extraction process. Some
>synthetics, he said, are old and off patent, which public health
>officials like but pharmaceutical companies do not, because they make a
>larger profit from drugs on which they have patent monopolies.
>
>No company has registered artemisinin in the United States, said Dr.
>Nick White, a professor of tropical medicine at Mahidol University in
>Thailand, because sales would be too small to justify the cost of
>seeking approval from the Food and Drug Administration.
>
>Now, with more purchases, fears of a shortage that would push prices up
>are developing. The W.H.O. estimates that 100 million doses will be
>needed by late 2005, and the world now has only about a third of that.
>
>Though it grows wild even in the United States, wormwood is cultivated
>only in China, Vietnam and pilot projects in Tanzania and India. It is
>planted in December and needs eight months to mature. Drug companies
>want firm orders from donors before they try to triple production.
>
>Dr. Tan said he had seed banks ready to plant 62,000 acres, "but we
>need to pay farmers to give up other crops and arrange for fertilizer."
>
>"Time is against us," he said.
>
>Even if enough artemisinin can be made, obstacles will arise, experts
>warned. For example, Dr. Kopano Mukelabai, a malaria specialist at
>Unicef, said shopkeepers would have to be trained not to sell one or two
>pills to patients who lacked the money for a full course of 12.
>
>And what Richard Allan, director of the Mentor Initiative, a public
>health group that fights malaria epidemics, called "the love of
>chloroquine" will have to be broken. That quinine derivative, in use
>since the 1950's, is now almost useless against parasites, but poor
>people still buy it because it is cheap and lowers fever as aspirin
>does.
>
>Also, counterfeiting will become a problem. In Kenya in 1997, Mr. Allan
>said, he found 120 versions of sulfadoxine-pyrimethamine for sale,
>"ranging from very good drugs to talcum powder." A recent study of
>artemisinin drugs in Asia "found that 38 percent were fakes," he said.
>"We can expect the same thing to happen in Africa."
>
>He favors giving artemisinin away to remove the counterfeiters' profit
>motive.
>
>http://nytimes.com/2004/05/10/health/10MALA.html?hp=&pagewanted=print&positio
>
>--
>art fougner, md
>ich bin ein New Yorker
>
--
art fougner, md
ich bin ein New Yorker
