In a small clinic in New Abirim in southern Ghana, doctors we met were worried about two issues: a surge in chronic diseases and the continued burden of malaria. As an FT special report on malaria shows, despite substantial progress in tackling the parasite, much still needs to be done to tackle the remaining 400,000 deaths each year.
Powerful drugs exist and there is widespread distribution of bednets. But resistance to treatments is emerging, while nets are uncomfortable and only partially effective. Mosquitoes, like the malaria parasite itself, have long found ways to adapt and survive.
Recent years have seen a strong focus on existing tools and funding innovations that offer prospects of new drugs, insecticides, vaccines and even genetically modified mosquitoes to reduce risks of transmission to humans.
Yet the wider use of diagnostics (which still need improvement) has shown many infections previously thought to be malaria are in fact other conditions for which basic antibiotics and other simple treatments are not available locally. Without broader strengthening of local health systems, momentum could be lost — or come at the expense of investments to tackle broader health conditions.
How will the pharmaceutical industry be rewarded for innovation in future?
Companies are going to be paid in future for the outcome they deliver rather than the number of pills dispensed. We are looking at medical value, quality of life, healthcare cost and societal value. A quarter of spending on healthcare is wasted today. In 20 years’ time data will be much easier to collect. We will get paid on outcomes not inputs. That’s how we are going to get sustainability into global health systems.
Will that apply in lower income countries?
In fast growing markets, we are trying to increase access to medicines rather than shift from transactions to outcomes. Our “Novartis access” brand has identified 15 patented and generic drugs for chronic disease sold at $1/month through governments. We have started in Kenya and Ethiopia and will roll out to 20m patients in 30 countries by 2020. But it’s not enough to provide the medicines. We are testing telemedicine to increase access to healthcare. Infrastructure is probably the biggest barrier.
What about your work around malaria?
We continue to be very dedicated to our initiative. We have committed to distribute up to 100m of our three-day treatments a year at zero profit and will continue. At the same time, resistance is starting to emerge so we have a research programme with two new compounds that could be the next generation of treatment. And we are looking with partners at new emerging technologies.
Beyond the pill US investors are betting on technology to transform healthcare. A total of $4.2bn was ploughed into the sector last year, with analytics and big data attracting $341m over 22 deals, more than double 2015. Babylon, the UK tech group, is building an “AI doctor” to diagnose illness. (FT)
Pandemic preparedness An alliance of health charities called on G20 ministers to step up preparations for pandemics. The World Bank reckons that without extra investment, diseases such as TB and malaria will push an additional 28.3m people into poverty, increase global healthcare costs by $1.2tn and cost low-income countries more than 5 per cent of GDP by 2050. (Guardian, Devex)
Hepatitis update The World Health Organization said 325m people were living with a chronic hepatitis B or C infection. Most lack access to treatment and many are at risk of chronic liver disease, cancer and death. Viral hepatitis caused 1.34m deaths in 2015, comparable to TB and HIV. (WHO)
Yaws on the brink A neglected tropical disease affecting children in poor countries is on the verge of eradication — the biggest victory against a human pathogen since smallpox in the 1980s. EMS, the Brazilian pharma company, is donating 40m tablets of its azithromycin antibiotic this year, which can cure yaws with a single dose. (FT)
Pollution and politics We already know that dirty air kills 3m people each year but now there are fresh insights into how the tiny particles we breathe in contribute to heart attacks and strokes. A political row broke out over a delay to the UK's clean air plan while the American Lung Association ranked the worst US cities for air pollution. (FT, New Scientist, CBS)
Not to be sneezed at An MIT mathematician takes a microscopic look at how the droplets from our sneezes — or from toilet flushes — spread viruses. (NPR)
Pharma results New GSK chief Emma Walmsley began her job with a 20 per cent rise in Q1 sales but warned of generic competition for respiratory drug Advair. Eli Lilly had good news on earnings and trials of its breast cancer drug. No such luck for the UK's Circassia, where losses widened after allergy trial setbacks. AstraZeneca was hit by generic competition — and a shareholder rebellion on pay. (FT)
Pharma lobbying US-style With healthcare reform the first priority of the new Congress, industry lobbyists have been in overdrive. No less than $50.9m was spent by 38 big drug companies and trade groups in the first quarter via 600 lobbyists, up from $10.1m in the same period last year. (Kaiser Health News)
Pharma lobbying UK-style As Britain geared up for the June general election, the Association of the British Pharmaceutical Industry demanded an increase in health spending from 9 to 11 per cent of GDP and warned the UK could become “a desert for healthcare innovation”. (ABPI, Times)
Brexit blues A report from MPs on the effect of Brexit on health and social care underlined the challenges facing Britons if reciprocal treatment arrangements with the rest of Europe are lost. The European Medicines Agency faces a €400m bill for 20 years of rent after it relocates from London. (Commons Health Committee, FT)
New push on US reforms Despite tweaks to appease hardline conservatives, a new vote on President Trump’s proposals to replace Obamacare failed to materialise. The president sacked Vivek Murphy, US surgeon-general. (Forbes)
Invisible implications A new technique called Clarity turns bones transparent to let scientists see into their marrow, with encouraging implications for bone disease research. (Stat)
Fat-free disease An editorial that says saturated fat does not clog arteries and that heart disease is a chronic inflammatory condition is coming under fire from organisations such as the American Heart Association. (British Journal of Sports Medicine, CNN)
Medieval medicine Is there any solid science behind the old-time cures? Ancientbiotics brings medievalists together with modern scientists to see if answers to the antibiotic crisis can be found in medical history. It turns out the Dark Ages weren’t so dark after all . . . (CNN/The Conversation)
Best of the journals
Cancer drug fund fails The British mechanism to pay for medicines judged not to offer value for money has helped neither patients nor society. There is no empirical evidence to support a “drug only” ringfenced cancer fund. The FT argued the same in 2014. (Annals of Oncology, FT)
Tackling post-partum haemorrhage The low cost use of tranexamic acid reduces death due to bleeding. (Lancet)
Womb service Researchers have tested an artificial womb on a lamb foetus — a regular stand-in for its human counterpart — raising new hopes for premature babies. Infants born between 22-23 and 26 weeks currently have just a 30-50 per cent chance of survival. (Nature, FT)
Operating profits US surgeons are turning away from research as demands on their time from revenue-hungry hospitals increase. This is bad news for translational medicine and the development of medical ideas into surgical practice. (Nature)
Excessive exercisers Although addiction to exercise is not officially classified as a mental health disorder, it has similar effects to other addictions. Therapy can help patients recognise their behaviour and reduce routines to avoid eating disorders, injuries and disturbed heart rhythms. (BMJ)
Waist not A new study reinforces evidence that waist size is better at predicting death than BMI (body mass index). The UN said Latin America faced a “frightening” future because of the double burden of undernutrition and obesity. (BMJ, UN news centre)
Binge boozers beware Aside from increasing that waist measurement, excessive drinking can also disrupt heart rhythms. The research in Munich was carried out on revellers at the city’s famous Oktoberfest. (European Heart Journal)
Podcast of the week
Return of the maggot: How doctors are adopting an ancient technique to help heal infected wounds. (Mosaic, 20m)
In case you missed it
Previous editions available on our Facebook page
Celebrating science With so much gloom for the future of science in evidence at last weekend’s rallies, we should take a moment to celebrate its successes. Look at the innovations coming in children’s health or check how life expectancy has increased over your own lifetime. How many extra weekends — or return trips to Mars — can you fit in? (FT/Reuters, CNN, Mosaic)