Out of order: You treat what you are

In 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 reality that such efforts, in Pécoul’s words, “are the exception rather than the rule.”

 

Despite such grand achievements, the developing world continues to be ravaged by microbial infection as the microbes evolve rapidly to resist every weapon in our therapeutic arsenal and infrastructure and social conditions slow the distribution of effective treatments and prophylactic measures.

 

And as I have written for almost two decades, the challenge isn’t restricted to the developing world. Drug resistance continues to be an issue in the developed world, where healthcare facilities face a constant battle to keep their patients clear of infections.

 

But if the ongoing conversations about vaccines are any indication, public concern over infection control and prevention in the developed world is a low priority, particularly when seen alongside diseases like the cancers. Thus, there are no Runs for River Blindness, Dances for Dengue or Vaults for VRE.

 

Instead, we grow our moustaches, wear blue ties, don pink everything and photocopy our backsides (a Canadian campaign for colorectal cancer). I am not arguing that these campaigns are a waste of time—I have several friends living the cancer experience—but short of having cures for the various cancers, we’ve gotten very good at turning many of them into chronic life conditions. And that is worth celebrating.

 

But in our focus on the dread C-word, we have developed therapies that cost tens to hundreds of thousands of dollars a year to administer, and it seems, help smaller and smaller patient populations.

 

Even I have contributed to this fixation, as four of the six DDNews Special Reports I have written in 2015 have focused on cancer. Even my last one of the year in this issue, touches on cancer despite the topic of epigenetics in autoimmune disease.

 

Type phrases like “methylation,” “histones” or “microRNA” into ClinicalTrials.gov and you are going to find dozens of trials in cancer before you find your first trial in autoimmune conditions like multiple sclerosis. PPD’s Gregory Dennis, company vice president of global product development, wasn’t surprised when I mentioned this.

 

“A lot of what we get in terms of directing our [autoimmunity] research comes from the area of cancer,” he explains. “When we identify agents or mechanisms that are particularly effective and impact the immune system in the treatment of cancers, we’ll very often explore their utilization in the treatment of autoimmune diseases.”

 

Perhaps this is the way forward in infectious disease.

 

As we improve our understanding of the human immune system through immuno-oncology, we can look for ways to apply those learnings to attack invading microbes. At the same time, is someone in rural Nigeria going to be able to afford or even access the latest PD-L1 or CTLA-4 modulator?

 

The developed world has largely forgotten the fear of widespread infectious disease…and that may yet haunt us.