Author Archives: jmcfarl1

Oral Rehydration Therapy and the Ebola outbreak

Diarrhea and the accompanying dehydration is the second leading cause of death in children under five worldwide. Since the early 1980s, the WHO and UNICEF have recommended oral rehydration therapy (ORT) to reduce mortality from number of diseases with diarrheal symptoms. The therapy is widely credited with preventing millions of deaths; it was adopted and utilized across Asia and Sub-Saharan Africa in the 1980s and 1990s, resulting in a decrease of 3.1 million deaths by 1999. ORT’s simplicity – it is a mix of clean water, salt and sugar – and its low cost appeared as an efficient, high-impact solution to the diarrhea issue.

The Ebola virus falls into the category of diarrheal disease and I wondered whether ORT was a part of the care for patients during the recent West African Ebola outbreak. Vaccines and targeted drugs for the disease are not fully developed yet, so the best medical advice right now is aggressive fluid replacement. Through a study of Ebola survivors, researchers learned that drinking 4 liters of rehydration solution daily is crucial.

However, it is really difficult for an Ebola patient to drink the fluids due to nausea, a common symptom of the disease. I can understand why it’s hard for Ebola patients to stay hydrated; one is simultaneously fighting to avoid vomiting and forcing a salty liquid down one’s throat. Flavoring the liquid may help. Orange-flavored granules are available and patients have said they are much more pleasant than the flavorless kind. This observation might be helpful intreating children who dislike the taste of ORS.

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Dr. Igonoh drinking her orange-flavored oral rehydration solution.

“As I took the ORS and treated dehydration, it provided me with energy, and my immune system was able to battle the virus,” said Ada Igonoh, a doctor who contracted Ebola while working in Lagos, Nigeria. Nigeria has rid itself of Ebola and has suffered fewer deaths compared to other countries in West Africa. The WHO’s interviews of several of the Nigerian survivors indicated that hydration was a factor in Nigeria’s lower fatality ratio. The WHO promotes Nigeria’s approach as the blueprint for other developing countries at risk of Ebola.

[1] Diarrhoeal disease. (2013, April 1). Retrieved December 5, 2014, from http://www.who.int/mediacentre/factsheets/fs330/en/

[2] Gale, J. (2014, November 17). Beating Ebola Means Drinking,  Last Thing Patient Wants to Do. Retrieved December 5, 2014, from http://www.bloomberg.com/news/2014-11-16/beating-ebola-hinged-on-sipping-a-gallon-of-liquid-a-day.html

Global Patent Law is an obstacle for the Developing World

In the publication “TRIPS and The Global Pharmaceutical Market”, Barton describes the effects of the Trade-Related Aspects of Intellectual Property Rights agreement on the global community. Access to medicines presents a conflict between the interests of social justice and the pharmaceutical industry’s interest in economic prosperity. By the end of this article, I was disappointed but not surprised to reach the conclusion that TRIPS protects private profit without as much consideration for the health needs of disadvantaged populations.

The patent system’s purpose is to permit an elevated price to fund research and development (R&D). TRIPS was put into place to extend patent protection. It required all World Trade Organizations to follow well-defined guidelines of intellectual property protection. The developed world readily accepted the agreement. The royalty costs to the developing countries would be greater, but in exchange, concessions were to be made that would expand the developing countries’ exports. In the late 1990s, NGOs became concerned about the detrimental effect TRIPS might have on developing countries. Patent law led to increased prices for pharmaceuticals, especially the prices of antiretrovirals used against HIV.

Patent Law

Dissent from individual countries led to compromise on pricing of drugs. Brazil could not keep up with the rising prices of imported medicines and threatened to grant compulsory licensing to allow production of medications under patent within the country. In 2001, differential pricing for poor countries and rich countries was introduced to appease developing countries. As it turns out, lower pricing does not improve access to medicine for patients suffering from HIV/AIDS in developing countries. The total amount of global health funds available are not sufficient to provide drugs for all the epidemic diseases, even when the drugs are available at low prices.

Disadvantaged populations do not reap the benefits of innovation. There is a lack of incentive for the drug industry to develop new drugs for the developing world’s market because this market has a limited magnitude. Simply put, there is no money to be made in the markets of poorer countries, so why incur costs of R&D for little returns?

The global patent law agreements have had the most impact on developing countries, but the United States should anticipate some impact as well. Developed countries such as the U.S. must prevent the low-priced products from being imported to the developed world. These imports would cut into this patent-protected market. To protect the developed market, the pharmaceutical industry has created ways of distinguishing low-cost drugs intended for developing countries by packaging and color.

This article raised an interesting point. How will Americans react when they discover that a drug is available to others at a far lower price? Yes, the people receiving the medicines at a discount are much less fortunate than we are, but the humanitarian angle is not a sufficient excuse for the price difference. The government and pharmaceutical companies will face political backlash. I do not think that the U.S. is currently capable of subsidizing pharmaceuticals to please the public. The coverage of pharmaceuticals  would be difficult to include in the Affordable Care Act. Alternatively, the U.S. can move toward public control of the drug prices and negotiated prices.

The article was written to discuss a global issue, throughly presenting each stakeholder’s vantage point. I had not been aware of the politics of patent laws as it pertains to the drug industry; the article did a great job of summarizing the issues and the history.