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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 www.DDN-News.com n Tel: (440) 331-6600 n Fax: (440) 331-7563