Drug Discovery Research and Public Health: New Exciting Discoveries amid Increased Challenges
This week we’re writing from the Offshore Technology Conference (OTC) in Houston, Texas, one of the world’s largest expositions and conferences for the energy industry. We will report back on developments at OTC and in the energy sector in next week’s update.
As we touched on last week, laboratory researchers in the public health and pharmaceutical industries are working very hard to face new challenges of disease outbreaks in our ever-changing world.
Indeed, the narrative of every improving public health care system in the Western world is coming under siege from several fronts: threats from new contagions spread by passengers traversing the world in transcontinental jets, the re-emergence of diseases once thought to be a thing of the past (like Pertussis, Measles and Polio), and — most ominously — threats to the very foundation of ‘modern miracle’ healthcare: antibiotics. Yet at the same time, laboratory scientists and genetic researchers are making incredible advances in drug discovery, such as promising new cures for the Hepatitis C virus.
Identification of a MERS-CoV Case in Indiana
Disease outbreaks are once again in the headlines this week. Just seven days since we mentioned the outbreak of MERS-CoV in the Middle East, public health officials have identified the first case in this disease in the United States — in Indiana. Laboratory researchers and public health officials continue to investigate this new, poorly understood disease as they look for ways to prevent its spread. An increasing factor that public health officials have to grapple with in recent times is that global air travel continues to increase dramatically, as fares remain relatively low and an increasingly large middle class can now afford to fly across the globe.
Compounding the problem is that areas which are potential hotspots for tropical diseases — such as Africa, the Indian subcontinent and Southeast Asia — are the same regions that airline industry analysts expect to experience the largest growth in passenger traffic during the coming decade. The bottom line is that diseases that once were isolated can spread rapidly through the airports of the world.
Unwelcome Return of Diseases like Polio, Measles, and Pertussis
But increased global travel and commerce is not entirely to blame for outbreaks of existing diseases that once were thought to be under control. Polio, which only a few years back had seemed oh-so-close to being eradicated once and for all, is making a comeback according to the World Health Organization (WHO). Uncontained outbreaks in Syria, Cameroon and Pakistan have spread to Iraq, Equatorial Guinea Afghanistan respectively. These outbreaks threaten the accomplishments of a 25-year campaign that sought to eliminate this terrible disease by vaccinating upwards of two billion children around the world. Other diseases, such as Pertussis (Whooping Cough) and Measles are making a surprising and disturbing return across the United States. An infant here in the Austin area died this past March from Pertussis.
Epidemiologists use the term ‘Herd Immunity’ to describe the need to vaccinate a sufficiently large portion of the population to beat back transmission of disease infections. Today however many parents are choosing to ‘opt out’ of vaccinating their children, which has public health officials concerned. They worry it not only puts the un-vaccinated children at risk, it also puts the entire community at risk. Increased rates of Autism seem to be on the mind of those parents who choose to opt-out of vaccinating their children. And there’s no question that the rate of autism among the very young is alarming; the Center for Disease Control (CDC) now estimates that one in 68 children born today can be classified on the autism spectrum. Yet laboratory researchers and epidemiologists continue to urge parents in public health campaigns that vaccinations are not to blame and they must immunize their children.
WHO Sounds the Alarm: Are We at the End of the Golden Age of Antibiotics?
This recent debate over vaccinations may soon be taking a backseat however as an even larger impending crisis in public health looms on the horizon. For years many scientists have been sounding the alarm over the widespread use of antibiotics: warning of the risks associated with over-prescribing antibiotics (to patients who have viral infections, for example), as well as adding antibiotics to livestock feed (which makes animals in our food supply grow more quickly). This past week, WHO issued an important report that announced the end of the antibiotic era is upon us:
“Without urgent, co-ordinated action by many stakeholders, the world is headed for a post-antibiotic era, in which common infections and minor injuries which have been treatable for decades can once again kill,” said Dr Keiji Fukuda, WHO Assistant Director General for Health Security. “Effective antibiotics have been one of the pillars allowing us to live longer, live healthier, and benefit from modern medicine. Unless we take significant actions to improve efforts to prevent infections and also change how we produce, prescribe and use antibiotics, the world will lose more and more of these global public-health goods and the implications will be devastating.”
And if that information wasn’t frightening enough, yesterday the White House issued a comprehensive report on the effects of climate change, including predictions of an increased number of droughts and more torrential rainfall and flooding. From the public health point of view, these type of environmental changes can provide opportunities for contagions to migrate from different regions of the world, with new and unexpected public health outcomes.
Is There Anything Optimistic in the News for Public Health?
Yes, there is some good news for public health. A Gallup Poll this week indicates that the number of uninsured Americans has dropped to 13.4% percent, which is the lowest number since before the Great Recession of 2008-2009. From a public health perspective, this is good news because more people will likely get better medical attention, including preventive care. Also, a new study published in The New England Journal of Medicine indicates that long-term effects of Type 2 Diabetes, like heart attacks and strokes, have dropped significantly– in some cases by half or more. One possible explanation may be the intensive efforts made by healthcare providers to educate diabetic persons in ways to maintain their health and prevent complications from this terrible disease.
Advanced Laboratory Research is Delivering New Drug Discoveries
Another public health breakthrough is the availability of new treatments for the Hepatitis C virus — Sovaldi by Gilead Sciences and Olysio by Janssen Therapeutic. Before the advent of these new treatments for the Hepatitis C virus, the best treatment available for this terrible, debilitating and ultimately fatal liver disease was a liver transplant. But laboratory researchers from Gilead Sciences and Janssen Therapeutic have developed treatments which can cure many Hepatitis C patients in a matter of months — without the need for a liver transplant — saving many thousands of dollars in surgical and hospitalization costs per each patient.
This treatment, however, is not without controversy. The companies are pricing their drugs based on the value they deliver. Consequently, these new miracle treatments can cost upwards of $100,000 per patient. (In one case, it was determined a single tablet cost $1,000.) Company representatives say this is necessary to pay for drug discovery research and development — not only for these new Hepatitis C treatments but also to recover the cost of the many millions of dollars spent on drug development research and testing for those drugs which did not pan out.
Pressure on Pharmaceutical Companies to Develop So-Called ‘Blockbuster Drugs’ is Enormous
Investors and pharmaceutical stocks take note of the specific patent portfolios held by each of the pharmaceutical companies. Stock valuations and company returns can jump sky-high when there are a series of ‘Blockbuster Drugs’ in the drug discovery pipeline. But once that pipeline begins to dry up, they are vulnerable to competition and lower profits as each drug patent expires. Without patent protection in place, generic drug manufacturers are eager to step in and offer lower cost (and lower profit) generic versions of these drugs, which can wipe out millions of dollars of stock valuation for the original drug developer.
Pfizer’s Hostile Takeover Bid for AstraZeneca
This drug pipeline story has played out in the business press for the past few weeks as U.S.-based Pfizer, which is looking at a diminished drug pipeline, has made an unwelcome bid to acquire AstraZeneca, the UK’s second-largest pharmaceutical conglomerate. This would be one of the largest takeovers of a UK company history. It’s so large in fact that political pressure and potential tax loopholes may convince Pfizer to leave the United States and repatriate itself as a UK-based operation. According to a Financial Times editorial (free subscription required), a re-organized Pfizer domiciled in the UK could access all its extensive overseas profits without paying the U.S. Treasury. Nonetheless, AstraZeneca continues its fight to remain independent.
It’s Not Just Drug Executives: Now Scientists are at Odds Over the Business of Gene Therapy
Open warfare over patents and the ethical aspects of business practices of the pharmaceutical industry are not limited to the Pfizer and AstraZeneca bidding war. Scientists and laboratory researchers continue to argue over ethical and fair ways to commercialize new discoveries in medical science, such as those made from the sequencing of the human genome. (You may recall we just discussed the sequencing of the human genome in a previous article.)
This issue has flared up again over the discovery of new technique for ‘gene editing’, known as the Crispr gene editing technique which promises to revolutionize disease control by making it possible to replace defective genes with ‘good’ genes. There is little celebration in the laboratory however. The scientists who discovered this gene therapy technique, Emmanuelle Charpentier of Hannover Medical School in Germany and Jennifer Doudna of the University of California, Berkeley, have split into two warring factions, each backed by a different consortium of eager venture capitalists who want to earn billions of dollars from these new gene editing techniques. We will be following this story closely and will provide an update in a future report.
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