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Friday, July 13, 2012

Artemisinin

As is often the case, one post leads to another.  I don't have time to track all of this down right now, but I looked up the "hard-to-get" drug Artemisinin mentioned by Roger Bate, and found that it's actually a natural product produced by the wormwood plant, that has been used as a remedy for malaria for millenia.  There is a touching story of a Chinese scientist who tracked down a bunch of folk remedies, including this one, and managed to get a patent on something containing it in China.  And of course, Novartis stepped in and got world-wide testing and approvals.  Oh, and good old Novartis also distributed it at cost in the third world, saving hundreds of thousands of lives.

The artemisinin-based product is called Coartem, and there's also a product called Coartem Dispersible.  All patented, but Novartis generously supplies them at cost, as above, saving many lives.  But if that's true, then why is the WHO buying it from Indian and Chinese manufacturers?  This all bears further investigation.  Interestingly, the wikipedia article on Coartem has the following legend:  "This article appears to be written like an advertisement. Please help improve it by rewriting promotional content from a neutral point of view and removing any inappropriate external links. (January 2011)"

Here's something from the wikipedia article:


The combination artemether/lumefantrine (trade names Coartem and Riamet) is a fixed-dose combination artemisinin-based combination therapy (ACT) indicated for the treatment of acute uncomplicated Plasmodium falciparum malaria.   The individual drugs were both initially developed in China. Artemether is one of the semi-synthetic derivatives of artemisinin, and lumefantrine (also known as benflumetol and CGP 56695 during development) is purely synthetic. The combination is an effective and well-tolerated malaria treatment, providing high cure rates even in areas of multi-drug resistance.


The reference to Artemether as a "semisynthetic derivative" is interesting.  I wonder what "semi-synthetic" means in this context.  An online medical dictionary gives two choices:


1. Prepared by chemical synthesis from natural materials, as of a pharmaceutical. 


2. Consisting of a mixture of natural and synthetic substances.

I'm guessing it's choice number two.  [update 8/3/12 -- a commenter who clearly knows more about this area than I do says that my choice is incorrect -- that "semi-synthetic derivative means that the starting material is natural and chemical syntheses are made from it," and that "[i]t is often used for increasing solubility or decreasing toxicity."  The commenter reports that Sanofi developed artesunate for solubility in water, since Artemisinin is insoluble in water.  Perhaps this suggests that Bate is being sloppy when he talks about the Artemisinin concentration in the supposedly-inferior Indian- and Chinese-supplied drugs.  As above, I'm still confused as to how it can be the case that Novartis is supplying coartem itself at cost, and yet WHO is still buying something with artemisinin in it from Indian and Chinese manufacturers]

Another interesting lead is this piece, in which it is claimed that artemisinin has cancer-fighting properties, but because it is so cheap to produce, the pharmaceutical companies are not interested in testing it.  Of course all that has to be taken with a grain of salt -- there are doubtless nutraceutical companies out there bottling the stuff and selling it at pharmacies and this could just be part of the campaign to persuade people that it does have cancer-fighting properties.


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So I tried to find information about lumefantrine, and I see that it is considered an "anti-malarial drug" (by Wikipedia), but that it is never used without Artemether.  So it's really just a scam, most likely.  Let's get a patent on this combination of a well-known folk remedy plus a placebo, and see how much money (or good publicity) we can make of it.   


Hey, coartem shows up as a "USPTO Patent for Humanity" here.


And now my googling for coartem takes me full circle to this 2007 article by Bate.  I don't want to be unfair, and I need to analyze the situation more closely, but the article seems to suggest that in 2007, Coartem was the best drug for fighting malaria, and yet everyone was using cheaper drugs with less quality control and that the result was that people were dying.  My guess is that 2007 was BEFORE Novartis started providing Coartem at cost, and the result was that people were using artemisinin-based drugs that were not patented.  And of course, he says that they were also using counterfeit drugs with no therapeutic effect whatsoever.  His 2007 article is thus a pitch for people to step up and buy the brand name drug, possibly at brand name prices (there's no mention of Novartis's sell-it-at-cost program).  


So the bottom line is that Mr. Bate has been working for Novartis for quite a while now.






2 comments:

  1. Your choice is incorrect. Semi-synthetic derivative means that the starting material is natural and chemical syntheses are made from it. It is often used for increasing solubility or decreasing toxicity. It is the case. Sanofi developed artesunate for solubility in water. Artemisinin is insoluble in water. An other example is the anticancer drug Taxotere from taxol.

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  2. Thanks for the clarification. I've updated the post to reflect your comment. As noted, I'm still confused about what's going on - if Novartis is supplying coartem itself at cost, then why is WHO still buying something with artemisinin in it (perhaps something not as effective as Coartem, a patent-for-humanity drug) from Indian and Chinese manufacturers?

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