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OUT OF ORDER: YOU TREAT WHAT YOU ARE
I
BY RANDALL C WILLIS
N EARLY OCTOBER, the world of infectious
disease—and more specifically parasitology—took center stage as the 2015 Nobel
Prize for Physiology and Medicine was
awarded to the scientists central to the discovery of two natural product families vital to the
treatment of parasitic roundworm and malaria.
William C. Campbell and Satoshi Omura
together share half the prize for their work in
the development of ivermectin and avermectin,
compounds that revolutionized the treatment of
lymphatic filariasis and river blindness, microbes
that still infect 120 million and 25 million people
worldwide, respectively.
The other half of the prize went to Youyou Tu
for her work in discovering artemisin, a compound that replaced the rapidly failing chloroquine in the treatment of malaria, a disease that
continues to threaten half the planet’s population.
There is no way to overstate the impact of these
therapeutics on the global stage, and the discoveries seem all the larger when one thinks to the individuals most directly impacted by the diseases.
“The fact that this Nobel Prize has been
awarded to parasitologists who devoted their
careers to the treatment of diseases that affect
poor populations in low- and middle-income
countries shows that research and development
can deliver concrete solutions of great importance to global public health,” said Bernard
Pécoul, executive director of nonprofit DNDi
(Drugs for Neglected Diseases Initiative), in a
press release.
But no sooner does the eye adjust to the gleam
of Nobel medallions than we must face the
it seems, help smaller and smaller
reality that such efforts, in Pécoul’s
patient populations.
words, “are the exception rather than
Even I have contributed to this fixathe rule.”
tion, as four of the six DDNews Special
Despite such grand achievements,
Reports I have written in 2015 have
the developing world continues to be
focused on cancer. Even my last one
ravaged by microbial infection as the
of the year, on page 20 of this issue,
microbes evolve rapidly to resist every
touches on cancer despite the topic of
weapon in our therapeutic arsenal and
epigenetics in autoimmune disease.
infrastructure and social conditions
Type phrases like “methylation,”
slow the distribution of effective treat“histones”
or “microRNA” into Cliniments and prophylactic measures.
Randall C Willis
calTrials.gov and you are going to find
And as I have written for almost
two decades, the challenge isn’t restricted to the dozens of trials in cancer before you find your
developing world. Drug resistance continues first trial in autoimmune conditions like multiple
to be an issue in the developed world, where sclerosis. PPD’s Gregory Dennis, company vice
healthcare facilities face a constant battle to president of global product development, wasn’t
surprised when I mentioned this.
keep their patients clear of infections.
“A lot of what we get in terms of directing our
But if the ongoing conversations about vaccines are any indication, public concern over [autoimmunity] research comes from the area of
infection control and prevention in the devel- cancer,” he explains. “When we identify agents
oped world is a low priority, particularly when or mechanisms that are particularly effective
seen alongside diseases like the cancers. Thus, and impact the immune system in the treatment
there are no Runs for River Blindness, Dances for of cancers, we’ll very often explore their utilization in the treatment of autoimmune diseases.”
Dengue or Vaults for VRE.
Perhaps this is the way forward in infectious
Instead, we grow our moustaches, wear blue
ties, don pink everything and photocopy our disease.
As we improve our understanding of the
backsides (a Canadian campaign for colorectal
cancer). I am not arguing that these campaigns human immune system through immunoare a waste of time—I have several friends liv- oncology, we can look for ways to apply those
ing the cancer experience—but short of having learnings to attack invading microbes. At the
cures for the various cancers, we’ve gotten very same time, is someone in rural Nigeria going to
good at turning many of them into chronic life be able to afford or even access the latest PD-L1
or CTLA-4 modulator?
conditions. And that is worth celebrating.
The developed world has largely forgotten the
But in our focus on the dread C-word, we have
developed therapies that cost tens to hundreds fear of widespread infectious disease…and that
of thousands of dollars a year to administer, and may yet haunt us. n
Reprinted with permission from DDNews n November 2015, Volume 11, Issue 11
Old River Publications, LLC n 19035 Old Detroit Road n Rocky River, OH 44116
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