By Anonymous (not verified) on April 27, 2010

Last month, a group of congressmen and congresswomen led by Rep. Donald Payne, D-N.J., wrote to the head of USAID, Dr. Rajiv Shah, with a simple message: We need to do more to fight neglected tropical diseases.

In its Global Health Initiative, the Obama administration has vowed to devote unprecedented resources to the fight against five parasitic and bacterial diseases damaging impoverished and remote communities throughout Africa, Asia and Latin America.

But the historical importance of the initiative is undercut by a bewildering and glaring omission: So far, several neglected diseases — including sleeping sickness, visceral leishmaniasis, Chagas disease and Buruli ulcer — have been completely left out.

The 14 diseases listed as neglected tropical diseases by the World Health Organization affect 1 billion of the poorest people in some of the world’s most remote areas. The majority of patients cannot afford to pay for any kind of treatment and thus represent no market for the drug industry’s research and development agenda. The Global Health Initiative should include all of these diseases.

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As doctors, we cannot simply choose which diseases to treat.

Sleeping sickness and visceral leishmaniasis are both 100 percent lethal without treatment, taking the lives of more than 100,000 people each year in sub-Saharan Africa and South Asia.

Chagas disease kills more people in Latin America than any other parasitic disease, including malaria.

Others, including Buruli ulcer, may not be deadly but they affect some of most marginalized people in the world.

Both of us have seen first hand how neglect from the medical and research community only compounds the heavy toll taken by these diseases. Today, there is scarce access to diagnostics, and the medicines that do exist are unaffordable, have more side effects, and are difficult to administer in resource-poor settings.

Nearly half of all stage 2 sleeping sickness patients, for example, are still treated with melarsoprol, a 1940s-era arsenic-based drug that inflicts searing pain when injected into the bloodstream and kills one in 20 of those receiving it outright. Up to 30 percent of patients fail to respond to the treatment altogether.

Our frustration at having to treat sleeping sickness patients like this spurred us to work for better options. Doctors without Borders/Medecins Sans Frontieres and Drugs for Neglected Diseases initiative spent several years researching and developing a new combination treatment, using nifurtimox and eflornithine, that is safer, more effective, easier to administer and cuts treatment time in half. The new regimen has been adopted by some countries, but efforts for wider use need a jolt, just the sort of thing President Obama’s Global Health Initiative could provide.

In the past ten years, Doctors Without Borders has treated tens of thousands of people for neglected tropical diseases while Drugs for Neglected Diseases initiative and its partners have for the first time created a pipeline for improved medicines. Even if this is just a drop in the ocean, it shows how a relatively small investment can save lives today and help fuel innovation for tomorrow.

Allocating just 10 percent of the Global Health Initiative neglected disease budget toward research and development, for instance, could help deliver better treatments to patients within five years.

The diseases focused on by the Global Health Initiative certainly deserve increased attention and resources. But if such an important venture continues to exclude the bulk of tropical diseases, a historical opportunity will be lost and patients will be doomed to another generation of deadly neglect.

Dr. Unni Karunakara is the incoming president of Doctors Without Borders/Medecins Sans Frontieres (MSF) International Council. Doctors Without Borders won the Nobel Peace Prize in 1999. Dr. Bernard Pecoul is the executive director of the Drugs for Neglected Diseases initiative (DNDi). They can be reached at pmproj@progressive.org.

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By Wendell Berry

Manifesto: The Mad Farmer Liberation Front

Love the quick profit, the annual raise,
vacation with pay. Want more 
of everything ready made. Be afraid 
to know your neighbors and to die.
And you will have a window in your head.
Not even your future will be a mystery 
any more. Your mind will be punched in a card 
and shut away in a little drawer.
When they want you to buy something 
they will call you. When they want you
to die for profit they will let you know. 
So, friends, every day do something
that won’t compute. Love the Lord. 
Love the world. Work for nothing. 
Take all that you have and be poor.
Love someone who does not deserve it. 
Denounce the government and embrace 
the flag. Hope to live in that free 
republic for which it stands. 
Give your approval to all you cannot
understand. Praise ignorance, for what man 
has not encountered he has not destroyed.
Ask the questions that have no answers. 
Invest in the millennium. Plant sequoias.
Say that your main crop is the forest
that you did not plant,
that you will not live to harvest.


Say that the leaves are harvested 
when they have rotted into the mold.
Call that profit. Prophesy such returns.
Put your faith in the two inches of humus 
that will build under the trees
every thousand years.
Listen to carrion—put your ear
close, and hear the faint chattering
of the songs that are to come. 
Expect the end of the world. Laugh. 
Laughter is immeasurable. Be joyful
though you have considered all the facts. 
So long as women do not go cheap 
for power, please women more than men.
Ask yourself: Will this satisfy 
a woman satisfied to bear a child?
Will this disturb the sleep 
of a woman near to giving birth? 
Go with your love to the fields.
Lie easy in the shade. Rest your head 
in her lap. Swear allegiance 
to what is nighest your thoughts.
As soon as the generals and the politicos 
can predict the motions of your mind, 
lose it. Leave it as a sign 
to mark the false trail, the way 
you didn’t go. Be like the fox 
who makes more tracks than necessary, 
some in the wrong direction.
Practice resurrection.

Wendell Berry is a poet, farmer, and environmentalist in Kentucky. This poem, first published in 1973, is reprinted by permission of the author and appears in his “New Collected Poems” (Counterpoint).

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