It’s all in the title

September 16th, 2004 by Ben Goldacre in bad science, dangers, herbal remedies, nutritionists, PhDs, doctors, and qualifications, times | 2 Comments »

Ben Goldacre
Thursday September 16, 2004
The Guardian

· It’s hard to know who to trust these days, what with pseudoscientists pretending to have all kinds of qualifications and quoting authorities all over the shop. Susan Clark’s consistently entertaining “What’s The Alternative?” column in the Sunday Times recommends artemisinin this week, as an alternative herbal malaria prophylaxis for someone travelling to Asia. “The Global Fund to Fight Aids, Tuberculosis and Malaria is funding the shift to artemisinin-based combination therapies in 26 countries,” she says. Sounds good. I’ll do you a favour, and spare you the rant about how chloroquine costs 20 cents per treatment while fashionable ideas like artemisinin cost $2.40, and stick to more important facts. Like: artemisinin is a treatment for malaria, not a preventive measure, because its half-life is too short, and the excellent and sensible Global Fund does not recommend it as a prophylaxis, nor does it endorse anything, as it is just a funding body. Perhaps Susan Clark can’t tell the difference. Here’s hoping her readers are a bit more cautious.

· So who do you trust? What about a “consultant podiatric surgeon”? Sounds a bit like “consultant orthopaedic surgeon”, doesn’t it? Or “consultant vascular surgeon”? Except a consultant podiatric surgeon is just a chiropodist who has decided to charge a bit more. Nice move, but it’s hard to prove that the public have been misled here. Sorry, I mean to say they have “misunderstood” the innocent phonetic coincidence between “consultant orthopaedic surgeon” and “consultant podiatric surgeon”. So the British Orthopaedic Trainees Association has surveyed 262 members of the public, and what do you know: 95% thought that consultant podiatric surgeons had qualified as doctors, while only 9.5% thought chiropodists were doctors. Ker-ching. Mind you, 97.3% thought consultant orthopaedic surgeons had been to medical school, and even a few junior doctors got the answers wrong. In a world full of “Dr Gillian McKeith PhDs”, until the government starts protecting professional titles, and regulating all the people who have popped up to make money out of our obsession with health, I can’t start to think about the financial gain for these wily characters because (holds head sanctimoniously aloft), there are actually rather serious issues about what goes through the heads of people who think they’re giving informed consent to treatment by self-appointed professionals.

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2 Responses

  1. Ben Goldacre said,

    January 23, 2006 at 12:00 am

    World Health Chief Warns on Misuse of Malaria Drug

    New York Times
    Published: January 19, 2006

    Warning that misuse of the most promising new malaria drug could create an incurable strain of the disease, the new chief of the World Health Organization’s malaria program demanded today that 18 pharmaceutical companies stop selling some forms of the drug.

    After several of the companies refused the demand, Dr. Arata Kochi made an unusually strong threat for a W.H.O. official, saying that he would publicly name the companies still selling the drugs three months from now and, if they persisted, would try to disrupt sales of their other drugs.

    The new drug, artemisinin, a derivative of sweet wormwood isolated by Chinese scientists, is the most powerful new weapon in the antimalaria arsenal. Health agencies consider it the best hope for controlling malaria, one of the world’s leading killers, which takes over a million lives each year, mostly young children.

    But these agencies say artemisinin should be used only in a cocktail with other malaria drugs – usually with a slower-acting one that stays in the blood longer.

    Combination therapy – which is routine with AIDS and tuberculosis drugs – not only attacks a disease more effectively, but slows the emergence of microbes resistant to drugs.

    But at least 18 companies from Belgium, China, France, Ghana, India, Kenya, Switzerland and Vietnam make the drug as a pill that can be taken by itself – which doctors call monotherapy – and sell it cheaply in Africa, Asia and Latin America. People with fevers often buy drugs at small shops, without a prescription or a test to make sure their fever is malaria.

    That is a recipe for disaster, Dr. Kochi said.

    “We can’t afford to lose artemisinin,” he said. “If we do, it will be at least 10 years before a drug that good is discovered. Basically, we’re dead.”

    If companies refuse to stop selling artemisinin in monotherapeutic form, Dr. Kochi said, he will ask his organization to stop endorsing their other drugs, including AIDS drugs, that they sell to poor countries, and he will approach the Global Fund, the World Bank and other donors and ask them to stop buying from those companies.

    The World Health Organization, a United Nations agency, is usually far more cautious in its public declarations, seeking consensus from many member states before taking a position.

    Executives of some companies he named disagreed over how they would react.

    Dr. Robert Sebagg, head of access to medicines for Sanofi/Aventis, the world’s third-largest drug company, said it now sells two artemisinin cocktails and is withdrawing its old monotherapy products “step by step.”

    But Dr. Bruno Jansen, president of Dafra, a small Belgian company that makes drugs in generic form, argued that artemisinin monotherapy in China and Vietnam had virtually wiped out malaria there without creating resistance. Also, he said, patients often refuse combination therapy.

    In Burundi, Dr. Jansen said, at the government’s request, his company phased out its monotherapy and introduced blister packs combining artemisinin and amodiaquine pills, as recommended by W.H.O.

    “But patients refused to take the amodiaquine because it made them feel ill, and doctors refused to prescribe the combination,” he said. “Now monotherapy continues happily with illegal imports from Uganda and the Congo. That’s Africa.”

    Told of that, Dr. Kochi argued that giving patients anything they want, whether good for them or not, “was like saying you should sell heroin or cocaine because there is demand.”

    Dr. Yusuf Hamied, chairman of Cipla, the third-largest drug company in India, also disagreed with Dr. Kochi’s policy.

    Although Cipla makes a combination pill and he favors two-drug therapy, “all drugs should be available and doctors should decide what they want,” he said.

    Of Dr. Kochi’s threat, Dr. Hamied said: “I don’t think he can succeed in that. But that’s his prerogative.”

    No proven artemisinin resistance has been documented yet, but the history of antimalarial medicines is one of miracle cures that fade through overuse.

    Chloroquine, an artificial form of quinine that was developed in the 1940’s, proved so effective that world health authorities used it – in combination with a new pesticide, DDT – in a drive to eliminate malaria. But resistance became so common that chloroquine is now virtually useless against the disease, though it is still sold to Third World countries by some companies. Dr. Kochi explained that artemisinin, when taken alone, knocks fevers down rapidly but take seven days to cure most cases of malaria. When mixed with other drugs, a cure can occur in as little as three days.

    But many patients stop taking their pills as soon as their fever drops, and the parasites left in the blood when that happens are the most likely to be drug-resistant strains, which can be passed to other people by mosquito bites.

    The companies Dr. Kochi asked to stop making the drug in monotherapy form are these:

    Arenco Pharmaceutica and Dafra of Belgium; Cipla, GVS Laboratories and IPCA of India; ETDZS, Guilin Pharmaceutical Works, three connected Holley-Cotec Pharmaceuticals in Beijing, and Kunming Pharmaceutical of China; Sanofi-Aventis/Africasoins of France; Kinapharma of Ghana; Cosmos of Kenya; Mepha of Switzerland; and Mediaplantex, Pharbaco and Traphaco of Vietnam.

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