WHO and industry working together

World Health • March-Aprill992 WHO and industry working together African trypanosomiasis (sleeping sickness), which affects an es'timated 25 000 people annually, is fatal if untreated. The disease is caused by parasites transmitted by tsetse flies; it occurs in scattered foci throughout sub-Saharan Africa-an area of some 10 million km2• WHO estimates that over 50 million people in 36 countries are at risk of contracting the disea~e. The onset of sleeping sickness is characterized by malaise, fatigue and irregular, low fever. It is followed by a spectrum of symptoms, including somnolence, high fever, joint pains, swollen tissues and enlarged liver and spleen. As the disease progresses and the parasites invade the central nervous system, patients experience mental deterioration, seizures, coma and death. WHO and a major American pharmaceutical company, Marion Merrel Dow, have announced the first new drug in forty years for treatment of the disease. The new drug, eflornithine, has already been used to treat successfully more than 600 patients infected with the West African variety of sleeping sickness, most of whom were at an advanced stage of the disease. Very few side- effects were reported, an advantage over other drugs available until now. When eflornithine is administered intravenously-the most effective method-adverse effects are very rare; when given orally, however, it may cause mild diarrhoea, nausea and vomiting. Eflornithine was originally developed as a potential therapy for cancer, but promising experimental studies in animals were not replicated in clinical trials in man. However, research on the drug had clearly established its safety and tolerance in humans, so Marion Merrel Dow published their findings and offered it to scientific researchers. Or Cyrus Bacchi of the Haskins Laboratory, Pace University, New York City, was studying the metabolic pathways of trypanosomes under a grant from the UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TOR). It was he who first demonstrated in the laboratory that eflornithine worked against the multiplication system of the trypanosome parasites. "Marion Merrel Dow have offered WHO the rights, the patent and the technical know-how for the manufacture of eflomithine on a royalty-free basis," explained Or Tore Godal, Director of TOR. The pharmaceutical company will manufacture the drug in the USA and France and distribute it at cost price to hospitals and health centres in Africa. • New, safe and affordable drugs .. A new approach to teaching drug prescribing In medical schools , students ore traditionally taught qu ite a lot of theoretical pharmacology but for less about practical therapeutics. So their skills in choosing and prescribing drugs rationally remain undeveloped. If these students ore not taught how to choose and prescribe essential drugs rationally, they hove no alternative but to copy the prescribing behaviour of their more "experienced" col leagues oher they graduate. They will then be susceptible to influences which cause irrational prescribing because they had not been taught how to recognize and cope w ith such phenomena. Changing deeply rooted habits is very difficult. That is why we need to act before poor prescribing habits get a chance to develop. The Action Programme's model guide to good prescribing, produced by the W HO Action Programme on Essential Drugs, is a step in that direction. lt is based on on innovative training programme in rational drug prescribing developed at the University ofGroningen, Netherlands. The guide is intended to help students learn to think as they wil l hove!o in practice, by describing how to ana lyse and use the information available to solve a prescribing problem and decide on appropriate drug therapy, or whether drugs ore needed at a ll. The whole process from the patient's compla int to monitoring the results of a drug treatment is described step by step. The "how" and "why" of each stage is clarified, and illustrated by real life examples. The guide also explains how to develop a "personal " drug list, selected according to rational principles. The guide is at present being field tested by eight medical schools in developed and developing countries. 25