With the welcome attention to ‘neglected diseases’ such as malaria and tuberculosis associated with poverty, there is a tendency to forget the many health challenges such as heart disease, diabetes and cancer which wreak havoc in both worlds. These ‘shared diseases’ have dramatically different markets in both first and third world, and some thoughts about the disparity in options exposes some structural failings and innovation opportunities.
Leaving the development of diagnostics and treatments of such diseases and conditions to market forces, especially when intellectual property can be used to control entry of new players, will continue to render these debilitating but familiar illnesses a sad litany of social inequities. Are there ways that research-intensive solutions can be cooperatively generated that can grapple with this challenge?
More of the world dies of cancer than almost any other single disease. According to the WHO, cancer kills almost seven million people a year of whom about half are in the developing world. By comparison, AIDS-related conditions kill about three million people a year.
In the industrialized world, the availability of diagnostics and therapeutics for cancer, while often outrageously expensive, can lead to very favorable outcomes. In the poorer parts of the world, diagnostic technology, when available, is inadequate to the task, and few therapeutics are affordable. There are literally millions of people who die of cancer each year in the poorer parts of the world, many of whom could have had longer and more productive lives if the diagnostic and therapeutic options available to their rich neighbors were available to them.
With cancer, it is not the disease that is neglected, but the diseased.
Telomerase is an enzyme in human cells which repairs the ends of chromosomes, and is tightly regulated in normal and normally aging cells. However in tumor cells and tissues, telomerase is often wildly de-regulated, rendering such cells virtually immortal. As such, it has been viewed as the platform from which a key ‘silver bullet’ for cancer therapeutics, for diagnostics, for gerontology, even for production of stem cells, could evolve.
This was the focus of a fascinating press piece by Judy Foreman in 2003 called “Telomerase: a promising cancer drug stuck in patent hell?”