Sandeep Kishore is one of the winners of The Lancet-GHEC 2008 prize for his work in petitioning the WHO to include simvastatin (Zocor), a statin drug used for heart disease, on the Essential Medicines List (EML). The WHO approved the petition in 2007, adding the drug to the EML. A summary of Sandeep’s work is below.

Heart disease has now become the leading cause of death globally, with nearly 80% of worldwide deaths occurring in the developing world. Long considered a disease of affluent countries, heart disease presently claims twice as many lives as HIV/AIDS, tuberculosis and malaria in low-income countries. Higher rates of urbanization and tobacco use help explain this trend. However, while there has been much effort to enhance access of basic, essential medicines for infectious diseases, there has been comparatively little attention paid to curbing heart disease and related chronic diseases in the developing world.

To address this problem, our student group at Weill Cornell initiated a campaign to identify schemes to enhance access to life-saving medicines for heart disease. We petitioned the World Health Organization (WHO) that a statin drug be included on the Essential Medicines List (EML) or Model List. This list was established to provide guidelines for developing countries for selecting high priority drugs, which should be supplied to their citizens inexpensively. We chose simvastatin (Zocor), originally manufactured by Merck, based on its worldwide availability, cost-effectiveness and the interest of generic firms in producing it. According to the International Drug Price Indicator Guide and our consultations with global pharmaceutical firms, generic versions of the medicine presently cost $40/year –10 cents/day - down from the nearly $1,200/year a couple of years ago. Efficacy data consistently show that statins reduce low-density lipoprotein cholesterol (LDL) levels by 25-30% in individuals at high risk for heart disease. Critically, our research indicated statins were effective in different ethnic populations globally. Through collaboration with the Clinton Foundation, we felt confident that a high quality, reliable supply of statin drugs could be made available to developing countries.

In April 2007, the WHO approved our petition, adding simvastatin to the EML. This qualification now enables mass drug donations of the heart drug by all United Nations’ organizations to 156 national pharmaceutical inventories. Furthermore, national governments that work with the WHO are encouraged to recognize heart disease as a serious health concern. The EML has a proven track record of enhancing access to essential medicines. It is too early to know whether access to statins in poor countries has increased. We recognize that efforts to increase statin use in the developing world must be taken in parallel with similar cost-effective interventions, such as, national diet and exercise programs and campaigns to reduce global tobacco consumption. However, increased statin availability is a first step. We note that that this work was student-led, researched with assistance of medical librarians and supported by the Dean of our medical college. Its success indicates that activist university students and faculty can be primary players in making significant changes to global public health policy.

The application is publicly accessible via the WHO here: http://mednet3.who.int/EML/expcom/expcom15/applications/newmed/statins/Statins.pdf

Matthew Kirkman discusses the influence of the pharmaceutical industry on drug prescription practices.

Of the total NHS budget in England (£78 billion), over £7 billion is spent on drugs alone. (1) 80% is spent on branded drugs, which make up the minority of prescriptions by volume. (2) General practitioners (GPs) in the UK write approximately 650 million of the total 678 million prescriptions every year and, as such, are a big target for pharmaceutical companies hoping to push their products onto the market. (2) (3) At a time when minimising cost has become a national priority for the NHS (and indeed other healthcare systems across the world), it is necessary to ask what exactly can be done to reduce the expenditure on drugs, which account for the second largest chunk of NHS expenditure after staff costs. Whilst the primary focus of this article is the UK, many of the ideas have a wider relevance. Since generic drugs are in most cases significantly cheaper than their branded counterparts, this is primarily an issue of increasing generic prescribing. So, what exactly are generic drugs? (more…)

According to latest statistics, 80% of patients with cancer throughout the world no not have access to pain relief- a basic human right. Aditi Das finds out more about this shocking situation

Pain is a phenomenon that unites us all. We are all familiar with the sting of a paper cut, the throbbing of a headache and the discomfort associated with a sore throat. Few of us however, have any concept of the reality of pain in its bare, intense and excruciating form. Chronic pain leaves you unable to work, sleep, wash or even eat. It strips you of your livelihood and renders you as a burden on society. Evidently, ‘true pain’ is not a phenomenon that unites us all.

In a recent report entitled ‘Access to Pain Relief-An Essential Human Right’ (1) Vanessa Adams, a palliative care pharmacist for the charity Help the Hospices, investigated the worldwide accessibility of pain relief for terminally ill patients. Her damning report suggests that 80% of cancer sufferers worldwide do not have sufficient access to analgesia. Furthermore, it revealed that around 7% of patients who suffer from pain secondary to cancer could be easily relieved, but are not. (1) Moreover, as the term “palliative care” encompasses not only cancer patients but also those suffering from other diseases such as HIV, AIDS, COPD and renal disease, the figures above are thought to reflect a gross underestimate of the availability of pain relief worldwide. (more…)