Malaria, Money, and Medicine

 

By Aram Kim

 

In my senior year of undergraduate protein chemistry class, our professor, Doctor Gary Pielak told us that Anopheles (the mosquito that transmits malaria parasites) gene has been sequenced, but many people will continue to die from malaria regardless of the advance in our understanding of this disease transmitting vector.

He asked us why this was. Back then, I had little idea of how the world was and did not really know why. His answer left a deep impression on me for some reason; most of the people who get malaria are poor. There was no money to be made from treating malaria. It was difficult to wrap my head around the concept that economy was deeply tied to lives of thousands and millions of people.

Although only an annoying weekly pill to international travelers from North America, malaria is a complicated parasitic infectious disease(ID) that causes 350-500 million infections kills approximately 1.3 million people [1].

HIV/AIDS, tuberculosis(TB), and malaria form the global ID triad. Each of these IDs cause much grief in the individuals and their family and friends.

HIV/AIDS is a decade-long death sentence wrought with stigmata and secondary infections. There is no treatment for the diseases but it can be managed with extensive (and expensive) medical care. There is nothing I dislike more than HIV/AIDS on this side of the galaxy because it is the leading cause of orphaned and vulnerable children. This is the type of thing that keeps some of us up at night.

TB is similar to HIV/AIDS because its treatment is difficult and long (>6 months). Also multidrug resistance is slowly creeping up which drives the price of the medicine considerably.

Malaria, however, is different from HIV and TB.

Malaria is a white elephant in global health. It is an embarrassment to the humanitarian society. This is because, unlike HIV/AIDS, malaria has a cure. In fact, there are many cures. In the 1950’s North America was rid of malaria with the help of DDT and clinical public health measures. Who would have thought DDT saved so many lives?[2]

Also there are many medications available for malarial parasitemia. Center for Disease Control (CDC) recommends following medications depending on the clinical findings[3]:

  1. Chloroquine
  2. Quinine
  3. Malarone
  4. Mefloquine
  5. Doxycycline
  6. Tetracycline
  7. Clindamycin
  8. Primaquine


Of course, there are more treatments available there for a malarial infection. One of the notable treatment that is missing from CDC line of recommended drugs is artemisinin extract from qinghaosu plant.

Artemisinin extract is possibly the most effective anti-malarial treatment. The treatment lasts 7 days by artemisinin alone or 3 days in combination with other chemical anti-malarial medication[4]. Although I have not found any research paper on this topic just yet, it is widely reported that artemisinin does not cause adverse effect in people who are susceptible to hemolytic events (such as G6PD-deficiency) as it does with other kinds of peroxide-based, anti-malarial drugs.

Between CDC and WHO, there was much controversy on efficacy of artemisinin based therapy in the preceding few years. WHO adopted artemisinin based therapy based on its efficacy - especially in Sub-Saharan Africa where the parasites have developed resistance to first line malarial drugs. And CDC and FDA decided not to endorse the use of artemisinin based therapy for malaria in US for reasons I would rather not mention here.

Malaria brings up two good points about medicine and this world.

First, artemisinin is the perfect example of an herbal medicine that can be more therapeutically effective than a pharmaceutical solution with lesser side-effects. One has to wonder how many more wonder drugs like artemisinin are actually available unbeknownst to us in the nature and in unexplored CAM modalities for other ailments. Artemisinin is the reason why we should pursue scientifical understanding of CAM.

Second, the fact that good, feasible public health solutions exist to a public health problem does not mean that it will be solved on its own. Money affects population health outcomes so much more than understanding of medicine. As far as malaria is concerned, it is no longer a matter of research but an issue of resources. Where can we find the resources and who will channel these resources effectively? Whoever can fulfill this role, I believe, fits the definition of a holistic healer and a holistic man.

1. Scott P. Layne, M.D. UCLA Department of Epidemiology, "Principles of Infectious Disease Epidemiology / EPI 220"
2. New Yorker, “The Mosquito Killer”
3. CDC. “Treatment of Malaria (Guidelines for Clinicians)”
4. WHO. “Facts on ACTs”