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politics - 13 01 2003 - 00:08 - katatonik

Malaria and DDT, facial hair and DFMO

”... Federal Bodysnatchers contains other examples of how misplaced emphasis on financial considerations has had disastrous consequences for human health. In the 1950s and 1960s, Desowitz worked for the World Health Organization’s ill-fated Global Eradication of Malaria Campaign. The achievements of the campaign were uneven, mainly because malaria is very difficult to control. The campaign also relied heavily on the much-maligned insecticide DDT. However, Desowitz shows that for all its flaws, the Malaria Eradication Campaign, which ended in the early 1970s, looks pretty good today. For example, in India the number of annual deaths from malaria went from 800,000 at independence in 1948 down to zero eight years later, when the eradication campaign was underway. After the eradication campaign ended, malaria started killing Indians again, and in 1994, 20,000 died from the disease.

Today, malaria kills more than one million people every year. Current WHO strategy, based on finding sick people, treating them with antimalarial drugs, and advising people in malarious areas to use insecticide-treated bed nets, has made little headway so far. This is so partly because malaria is most widespread and severe in places where health services can’t reach people in time to give them the drugs that could save their lives. In addition, most people who live in malarious places cannot afford bed nets or the insecticide they need to be dowsed in.

It turns out that DDT was really the fallen hero of the old Malaria Eradication Campaign. DDT is cheap, and spraying it on the walls of a house twice a year can effectively kill or repel mosquitoes. DDT will not solve the global malaria crisis, but it can make a difference and it is appropriate for use in developing countries. There is also no evidence that it is more toxic to the environment or to human health than many other insecticides when it is used in the small amounts required for house-spraying to control malaria. However, in 1972 the US, once the major manufacturer of DDT, banned it. Today very few countries continue to make it, and WHO and the World Bank discourage the use of DDT in malaria control programs.

The DDT ban turns out to have been a triumph, not for the environmentalists, because many other pesticides are just as toxic as DDT, if not more so, but for the chemical industry. In the 1960s, these companies realized that DDT was unprofitable because it was so cheap. They wanted to clear the lucrative agricultural market to make way for newer, more expensive insecticides, so that when environmentalists, inspired by Rachel Carson’s passionate 1962 book Silent Spring, began to campaign for a DDT ban, the companies readily obliged. However, the ban on the manufacture of DDT was a disaster for developing countries, because it really does save lives, and there is currently no affordable alternative.[16]

That global markets do not respond to the needs of people who don’t have any money is hardly news. But when those needs are a matter of life and death, markets sometimes respond to the invisible hand of shame. In 1995, the pharmaceutical company Aventis stopped making the drug DFMO (also known as eflornithine), the most effective and safest drug for sleeping sickness, a parasitic disease that kills more than 60,000 people every year in developing countries. The victims are all poor and could not afford to buy the drug, even if the company charged them only the cost of manufacture. In 2001, another pharmaceutical company, Bristol-Myers Squibb, began marketing cream containing DFMO as a remedy for facial hair growth in women. This cream, known as Vaniqa, is now sold for considerably more than the cost of manufacture. As Desowitz points out, “Marketing DFMO as a prescription vanity cosmetic while denying it to those dying of sleeping sickness did not exactly project a favorable corporate image.”

The medical charity Médecins sans Frontières (MSF), which has criticized the pharmaceutical industry for neglecting the diseases of the poor, didn’t think so either. MSF began a cam-paign to encourage the companies to make the drug available. This led to a corporate-sponsored DFMO donation program for sleeping sickness patients in developing countries. Until 2006, MSF will receive free DFMO for use in its African clinics. However, in general, there is no market in the West for better medicines for other tropical diseases such as Kala-Azar, malaria, and lymphatic filariasis. Donation programs can help, but eventually more sustainable ways must be found to reconcile the health needs of the poor and the financial priorities of the pharmaceutical industry. Some form of government intervention will almost certainly be necessary.”

Helen Epstein reviews Robert S. Desowitz, “Federal Bodysnatchers and the New Guinea Virus: People, Parasites, Politics” (W.W. Norton, 2002).
The review appeared in the January 16 issue of the New York Review of Books (available only to subscribers. If anyone’s interested in the full text, drop me a mail.)

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