Brave New Drugs
Intoxicating ideas for saving a billion lives
David Nutt was no stranger to controversy by the time he was fired as chair of the UK’s Advisory Council on the Misuse of Drugs in October 2009, after claiming that alcohol is more harmful to health, and to society as a whole, than many illegal drugs—including cannabis, LSD, and ecstasy. Though not offering absolute legitimacy to reggae singer Bob Marley’s claim that “herb is the healing of a nation, alcohol is the destruction,” Nutt called for the use of scientific evidence to inform policy and ran up against a government that didn’t “want facts to get in the way of prejudice.”
Two months after being sacked he launched the Independent Scientific Committee on Drugs, with a mission to “investigate and review the scientific evidence relating to drugs, free from political concerns.” The indie group’s first major study was recently published in The Lancet (Nov. 6) expanding on Nutt’s earlier ranking of harmful drugs, with particular emphasis on the harms of alcohol. For revelers picking up this magazine after multiple toasts to welcome in 2011, an essay presents his thought experiment on developing a safer, synthetic alternative to alcohol, whose effects could be reversed by antidotes. A revelation! As many revelers can attest, along with George Bernard Shaw, “alcohol [substitute] is the anesthesia by which we endure the operation of life.”
The quest for independence from politics, profits, and influence peddling by megacorporations also underlies the surprising emergence of nonprofit pharmas, as reported in this issue. Chemist Victoria Hale established two nonprofit companies because she wanted to create affordable drugs for people suffering from disease in developing countries. Funded partially by the Bill & Melinda Gates Foundation, Hale’s Institute for OneWorld Health (iOWH) has succeeded in bringing drugs to market by partnering with for-profit manufacturing facilities. The article’s sidebar describes a “brave new world of creative structures and mechanisms”—other hybrid ventures encouraged by government initiatives, such as community interest companies (CICs) in the UK and low-profit, limited liability companies (L3Cs) in the US. These are stirring examples of governments rising above lobbyist influence to develop smart and novel policies.
Continuing on the indie theme, bioengineer, entrepreneur, and author Rob Carlson writes about “biohackers in the garage” who are tinkering with genomes to develop innovative approaches to making drugs and other products. This he puts in the context of the “prudent vigilance” recommendation issued in December by the Presidential Commission for the Study of Bioethical Issues, regarding how synthetic biology should be regulated in the US. Carlson warns that restricting access to these tools, in the name of public safety, could actually drive a dangerous black market, as did government efforts to regulate illegal drugs such as methamphetamine. While there is a need for oversight in this brave new world of genomic architecting, achieving sound policy while reaping the benefits of rapid innovation will require a public that can grasp the nuances of modern biomedicine and its methodologies. Hmmm, how and when is that transformation going to take place?
Yet the results are rolling in, leaving no doubt that small is beautiful. Examples of faster-better-cheaper? Yeast cells engineered to produce artemisinic acid, the precursor of a major antimalarial drug. Antibiotic treatment for visceral leishmaniasis, a parasite infection that kills 300,000 people annually, bringing treatment costs from $300 to $10–15. Flu vaccines developed in days to weeks rather than 12 months or more.
In the November 15 issue of The New Yorker, Michael Specter presents a disturbing narrative about epidemic tuberculosis, which claims a thousand deaths per day in India alone, and ten million new cases worldwide in 2010. Detection is key to curing infection, but there is no reliable, affordable diagnostic test. The GeneXpert device can diagnose TB almost without error in two hours, but costs an astronomical $25,000, and $20 per test. The article is basically a call to indie innovators to come up with affordable alternatives, with the nearly certain outcome of saving millions of lives.
And, if that isn’t a sobering task, how about garage-hacking synthetic alcohol? Just don’t forget the antidote.