The Raffles Dialogue on Human Wellbeing and Security
Authors: Boris Cvek
Journal: The Lancet Global Health (2016)

In The Lancet Global Health (August, 2015),1Pang T Chong YS Fong H et al.Yes we can! The Raffles Dialogue on Human Wellbeing and Security.Lancet Glob Health. 2015; 3: e496-e500Summary Full Text Full Text PDF Scopus (4) Google Scholar Tikki Pang and colleagues emphasise that “we must find the right balance between the roles of government and markets so that all those in need can access affordable medicine and health care“.1Pang T Chong YS Fong H et al.Yes we can! The Raffles Dialogue on Human Wellbeing and Security.Lancet Glob Health. 2015; 3: e496-e500Summary Full Text Full Text PDF Scopus (4) Google Scholar Probably the biggest imbalance between role of government and market is in drug discovery and development. There is almost no way to finance large clinical trials of old, unpatentable drugs repurposed for treatment of deadly diseases. It has been the case for phase 3 clinical trials of paromomycin, an old antibiotic for visceral leishmaniasis, which were funded by the Bill & Melinda Gates Foundation, the WHO, and other institutions, but not by governments.2Sundar S Jha TK Thakur CP et al.Injectable paromomycin for Visceral leishmaniasis in India.N Engl J Med. 2007; 356: 2571-2581Crossref PubMed Scopus (356) Google Scholar At the same time, such clinical trials may lead to very efficient and low-cost drugs developed in the public interest. The cost of paromomycin is €4·19 for a 21 day course for a 35 kg patient.3Davidson RN den Boer M Ritmeijer K Paromomycin.Trans R Soc Trop Med Hyg. 2009; 103: 653-660Summary Full Text Full Text PDF PubMed Scopus (133) Google Scholar Recently, The Oncologist published results of a clinical trial of an old drug used in alcohol-aversion therapy, disulfiram, in patients with metastatic lung cancer.4Nechusthan H Hamamreh Y Nidal S et al.A phase IIb trial assessing the addition of disulfiram to chemotherapy for the treatment of metastatic non-small cell lung cancer.Oncologist. 2015; 20: 366-367Crossref PubMed Scopus (116) Google Scholar The drug is unpatentable, inexpensive, and widely affordable, but there is no financial interest in its further clinical development. The governments, especially those of rich countries, should systematically monitor positive side-effects of existing drugs and invest in their clinical development as non-profit drugs.5Cvek B Nonprofit drugs as the salvation of world's healthcare systems: the case of Antabuse (disulfiram).Drug Discov Today. 2012; 17: 409-412Crossref PubMed Scopus (79) Google Scholar I declare no competing interests. The Raffles Dialogue on Human Wellbeing and Security – Authors' replyWe thank Boris Cvet for his comments on our Article1 and agree with him that discovering new uses for old drugs offers great promise with regard to making treatments for neglected tropical diseases in low-income and middle-income countries more cost-effective and accessible. This is an important and neglected area.2 While we agree with Cvek that an imbalance exists in the role of governments and markets in investing in drug discovery and development, we propose that this is only one dimension of the problem. Full-Text PDF Open Access