Earlier this year, the CBC reported that Canadian international development funding was being used to deliver homeopathic treatments to patients with Chagas disease (American trypanosomiasis) in Honduras. Medical experts were quick to raise serious concerns about public funds being used to help deliver unproven treatments to vulnerable people who are sick with a potentially fatal disease. In response, the Minister responsible announced that Canada would no longer be providing funding for homeopathy as part of its international development programming.
The medical community is right to be concerned: As many as 6–7 million people are estimated to be infected with Trypanosoma cruzi, the parasite that causes Chagas disease, which is transmitted by the bite of “kissing bugs” or from infected mothers to their babies, and can cause heart failure, among other complications. The medicines currently available to treat Chagas disease, benznidazole and nifurtimox, are more than 40 years old, and as currently administered, require long treatment courses and have significant side effects. Today, less than one percent of patients with Chagas in need of treatment are receiving it. We need both an improved understanding of how to optimize the safety and effectiveness of the current drugs, and eventually, newer, improved medicines.
But amid the outrage that the CBC articles on homeopathy have provoked, we must not lose sight of the bigger picture.
Chagas is just one of 20 different diseases considered by the World Health Organization to be Neglected Tropical Diseases, or NTDs. This diverse group includes rabies, snakebite envenoming, leishmaniasis and others—diseases for which available treatments are often ineffective, toxic or absent altogether. This neglect persists despite more than one billion people around the world being affected by NTDs.
And yet, evidence from over a decade of research and development (R&D) for neglected tropical diseases shows that new medicines—and new formulations of existing medicines—can be developed and delivered affordably and efficiently. Take sleeping sickness (or Human African trypanosomiasis, the African form of Chagas disease): It is endemic in 36 African countries, but until recently, the most effective treatment was a combination of two medicines that, among other things, required patients to be hospitalized in order to receive infusions of the drugs over many days and undergo invasive testing to determine the disease stage. This replaced a more toxic drug, melarsoprol, that was derived from arsenic and killed roughly one in 20 patients who received it.
But beginning in 2005, the Drugs for Neglected Diseases Initiative (DNDi) identified a promising, previously abandoned medicine called fexinidazole and conducted a series of randomized trials in the Democratic Republic of Congo and Central African Republic. DNDi is a not-for-profit pharmaceutical research and development organization founded by seven founding partners that initiates and coordinates R&D with an international research community of scientists, the public sector, the pharmaceutical industry, and other partners—without having labs or manufacturing facilities of their own. On the basis of their studies, in 2018 the European Medicines Agency recommended fexinidazole for the treatment of sleeping sickness and it is a game changer: It is an all-oral cure taken over 10 days, rather than an infusion or an arsenic-based treatment, which treats both stages of the disease.
DNDi has also developed treatment protocols for and delivered seven other treatments, which include a new pediatric formulation of benznidazole for Chagas, two fixed-dose combinations of anti-malarial drugs, and new treatment regimens for visceral leishmaniasis, among others.
The R&D model that DNDi uses prioritizes patients’ needs by, first, prioritizing diseases where patient needs are glaring or which pose a significant public health burden, and second, developing formulations that are adapted to patients’ needs such as fixed-dose combinations, pediatric formulations, and shorter treatment regimens. DNDi makes scientific data freely available, reports openly on R&D costs, and applies policies that ensure the medicines they develop are priced affordably. Through a more flexible, principled model, DNDi reports they can develop a new medicine for approximately CAD $150–225 million and improve an existing treatment for between CAD $13–60 million—a far cry from the billions the private sector says it costs them.
But NTDs are the “canary in the coalmine”—a signal that something is majorly wrong with the way that medicines are being developed and made available (or not) for patients. Drugs are increasingly becoming unaffordable for patients and health systems in Canada and virtually every other country around the world. Policymakers are wrestling with how best to respond to the epidemic of high prices, but unless we change the way that drugs are developed in the first place and experiment with new models of R&D—like DNDi —that can better ensure patient access to and affordability of final products and make data available (and R&D costs transparent), we’ll miss the big picture.
Canadians should rightfully be upset about ineffective treatments being used to treat Chagas disease, but they should also be outraged that this happens every day, for neglected tropical diseases that affect close to a billion people. Fixing this problem requires us to think beyond any one disease, and requires us to rethink the way new medicines are discovered and delivered in the first place. We need to ensure that our R&D systems prioritize patient needs over profits, that they promote collaboration over competition, and that they deliver effective, timely, and affordable medicines to patients, whether they are in Canada, Honduras or anywhere else.
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Oops..sorry about the typo there. Meant to say “Trudeau government’s” not “Trudeau’s government’s”.
Thanks for an interesting article! I’d be interested in hearing Dr. Nickerson’s views on the Trudeau’s government’s initiatives/non-initiatives regarding national strategies to cope with pharmaceutical prices.
Homeopathy works and was the original “pharmaceutical industry” although as like some medicines today, they don’t necessarily work on everyone the same way or with exact results.
When you give large, for profit, corporations (pharmaceutical industry) too much power(doctors promoting their products without really understanding what they do), there should be no surprise that they start to call the shots with pricing. The medical industry has promoted a strict regime of only looking in the mainstream pharmaceutical box for answers. There is much scientific evidence available and published in medical journals that supports alternative treatments such as homeopathy and the science shows they do not have the serious and potentially fatal consequences that mainstream drugs have,in many cases). Time to start thinking and learning out of the box in the interest of the patients paying your wage. Time to start doing your homework doctors and changing how you teach new practitioners to think and assess and prescribe. Maybe if this industry started putting the patient first and did a proper assessment up front we wouldn’t be looking at rising pharmaceutical costs and the proprietary shortages created by the drug companies.
It’s very frustrating to see that most medical professionals still want to think in the box, and yet they think things can change?
Do you have any actual evidence that homeopathy works or is this your opinion? If it is opinion please don’t call it evidence.
Rob, There is much literature and science behind homeopathy. The problem is science has not caught up to energetic medicine nor does the medical industry understand healing. Right now, the protocol, is conquer and control everything thing the body does that looks like a “symptom” . this suppresses the immune system yet stops for now the “Symptom” only to see it rear it head later or for the person to now have a low vitality and chronic disease. Homeopathy works but sometimes needs individualization because everyone is different, hence the problem that though there may be epidemic remedies that generally cover many , there is a need to understand the different manifestations of disease in different people. It is a complicated issue in a world that wants instant gratification, a world where FEVER is seen and bad and suppressed instead of encouraged in moderation to rid the energy of the disease. I suggest diving into the science of homeopathy or better yet, next time you want to try and get healthier , find an experienced trained homeopath and see for yourself.
Research is now being driven by shareholder preferences which means working on areas than insure quick sure profits. There is a lot of time and money involved in developing new antibiotics and vaccines and then where is the business model if you have cured something? SEE: The “Money Culture” in Academic Biomedical Research, A drive for revenue is damaging basic science, Opinion, Rubenson D, The Scientist.com 19-03-29: https://www.the-scientist.com/news-opinion/opinion–the-money-culture-in-academic-biomedical-research-65678
This for profit money drive takes medical research away from cure to ‘a drug for every symptom’. In Canada, relative to Lyme disease and tick-borne diseases [TBD’s], the private Association of Medical Microbiology and Infectious Disease of Canada [AMMI], is an extension of the ‘do not cure’ medical money machine. They offer opinion and poorly designed research to support the ‘do not treat the disease, drug the symptoms’ highly profitable model and, their influence is entrenched at every level of medical leadership in Canadian university medical schools and within the Public Health Agency of Canada. Canada is a dangerous place for the chronically ill despite the image they sell to the world. Canada prefers to ‘Farm sickness to Pharm sickness’ at the beckoning of AMMI’s partners… the private Infectious Disease Society of America and the non-transparent highly profit motivated United States Center for Disease Control, both of which are a huge part of the global medical for profit money machine.
Here’s another example of the distorted sense of priorities when we leave drug development to private companies. One of the older medicines for treating African sleeping sickness is eflornithine but its production was discontinued when it failed to show any usefulness as a treatment for cancer. (There wasn’t any money to be made selling it for sleeping sickness.) Then it was discovered that it was very effective as a depilatory agent (for the removal of unwanted facial hair in women). That made it commercially successful and manufacturing started up again and there was a side deal to make it available for sleeping sickness. For drug companies removing unwanted facial hair is more important than treating a potentially fatal disease.