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Fighting fake malaria meds
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shouldn’t be able to get an abortion or contraception without her parents’ involvement, or why we shouldn’t let 16-yearolds vote. Indeed, they can vote in Austria, Argentina, Brazil, Ecuador, and Nicaragua. I certainly wouldn’t recommend changing the age limit to 16 for all purposes, though. A later threshold is more sensible for matters that involve hot cognition, such as driving, drinking and criminal responsibility. Here the circumstances are usually those that bring out the worst in adolescents’ judgement. They frequently pit the temptation of immediate rewards against the prudent consideration of longterm costs, occur against a backdrop of high emotion, and are influenced by other adolescents. These are the very conditions under which adolescent decisionmaking is more impulsive, more risky and more myopic than that of adults. Given this, we ought to set the minimum driving age and the minimum age of adult criminal responsibility at 18, and continue to restrict minors’ access to alcohol, tobacco and, where it is legal, marijuana. Science cannot be the only consideration in drawing legal boundaries, to be sure, but it ought to play a role in these discussions. I don’t harbour any delusions about the use of scientific evidence to inform policy-making, though. If the political will is absent, no amount of science, no matter how persuasive, will change the law. Politicians and advocacy groups use science in the way that drunks use lampposts – for support, not illumination. That quip, ironically, originated from the pen of one Andrew Lang, a poet, scholar and son of Scotland. n Laurence Steinberg is professor of psychology at Temple University in Pennsylvania. His new book is Age of Opportunity: Lessons from the new science of adolescence (Eamon Dolan)
One minute interview
Fighting fake malaria meds A global health campaign is being undermined by criminal gangs and lack of vigilance, says epidemiologist Paul Newton Why are fake and poor-quality drugs a particular challenge in South-East Asia? Most countries in the area have endemic malaria and a high impact of infectious diseases. So there is high demand for anti-infectives, including for malaria. Criminal gangs exploit this demand for medicines, which are not always readily available in the more remote areas.
Profile Paul Newton is head of antimalarial quality at the WorldWide Antimalarial Resistance Network in Oxford, UK, and director of the Wellcome TrustMahosot Hospital-Oxford Tropical Medicine Research Collaboration in Laos
How big a problem are fake antimalarials? It’s big. A recent review by the WorldWide Antimalarial Resistance Network found that 30 per cent of malaria drugs tested globally failed either chemical or packaging quality tests. Of these, 39 per cent were fake. Many of the falsified pills were from southern China. Given the global burden of malaria, if even a small percentage of drugs are fake, it will translate into significant, and avoidable, increases in sickness and death. How vital is the distinction between the fake drugs and substandard ones? In essence, fake antimalarials are frauds, produced by criminals who intend to deceive health workers and patients. They contain none of the stated active ingredient. Substandard medicines, on the other hand, usually contain insufficient amounts of the active ingredient and result from negligent, but unintentional, errors in factory production. It’s an important difference as the root causes and solutions differ.
Resistance to antimalarials is growing in the region. Are fake or substandard drugs the cause? When taken on their own, fakes, which contain none of the active ingredient, will not risk resistance: there is no drug for any resistant parasites to survive attack from and then multiply. But if the antimalarial contains low amounts of active ingredient, susceptible parasites in the blood are killed but resistant ones multiply – and then are sucked up by mosquitoes to spread. The Greater Mekong area is now the epicentre for resistance to the most potent drug, artemisinin, and there are concerns this could spread to Africa, costing millions of lives. What other factors drive drug resistance? There are many: patients not taking full courses at the correct doses, availability of antimalarials over the counter and patients taking a single drug instead of a combined therapy. The World Health Organization recommends that artemisinin always be given with another antimalarial in the same tablet. The artemisinin kills most parasites in the first three days of treatment, then the partner drug eliminates the rest. How do you get fake drugs off the market? The steps that have been taken are woefully inadequate. The WHO estimated that 30 per cent of countries have effectively no drug regulation, and many of these have endemic malaria. Without functioning regulatory authorities, most interventions are doomed. To improve the quality of our medicine supply, we need much more international political will, backed by investment. Interview by Curtis Abraham
11 October 2014 | NewScientist | 31
shouldn’t be able to get an abortion or contraception without her parents’ involvement, or why we shouldn’t let 16-yearolds vote. Indeed, they can vote in Austria, Argentina, Brazil, Ecuador, and Nicaragua. I certainly wouldn’t recommend changing the age limit to 16 for all purposes, though. A later threshold is more sensible for matters that involve hot cognition, such as driving, drinking and criminal responsibility. Here the circumstances are usually those that bring out the worst in adolescents’ judgement. They frequently pit the temptation of immediate rewards against the prudent consideration of longterm costs, occur against a backdrop of high emotion, and are influenced by other adolescents. These are the very conditions under which adolescent decisionmaking is more impulsive, more risky and more myopic than that of adults. Given this, we ought to set the minimum driving age and the minimum age of adult criminal responsibility at 18, and continue to restrict minors’ access to alcohol, tobacco and, where it is legal, marijuana. Science cannot be the only consideration in drawing legal boundaries, to be sure, but it ought to play a role in these discussions. I don’t harbour any delusions about the use of scientific evidence to inform policy-making, though. If the political will is absent, no amount of science, no matter how persuasive, will change the law. Politicians and advocacy groups use science in the way that drunks use lampposts – for support, not illumination. That quip, ironically, originated from the pen of one Andrew Lang, a poet, scholar and son of Scotland. n Laurence Steinberg is professor of psychology at Temple University in Pennsylvania. His new book is Age of Opportunity: Lessons from the new science of adolescence (Eamon Dolan)
One minute interview
Fighting fake malaria meds A global health campaign is being undermined by criminal gangs and lack of vigilance, says epidemiologist Paul Newton Why are fake and poor-quality drugs a particular challenge in South-East Asia? Most countries in the area have endemic malaria and a high impact of infectious diseases. So there is high demand for anti-infectives, including for malaria. Criminal gangs exploit this demand for medicines, which are not always readily available in the more remote areas.
Profile Paul Newton is head of antimalarial quality at the WorldWide Antimalarial Resistance Network in Oxford, UK, and director of the Wellcome TrustMahosot Hospital-Oxford Tropical Medicine Research Collaboration in Laos
How big a problem are fake antimalarials? It’s big. A recent review by the WorldWide Antimalarial Resistance Network found that 30 per cent of malaria drugs tested globally failed either chemical or packaging quality tests. Of these, 39 per cent were fake. Many of the falsified pills were from southern China. Given the global burden of malaria, if even a small percentage of drugs are fake, it will translate into significant, and avoidable, increases in sickness and death. How vital is the distinction between the fake drugs and substandard ones? In essence, fake antimalarials are frauds, produced by criminals who intend to deceive health workers and patients. They contain none of the stated active ingredient. Substandard medicines, on the other hand, usually contain insufficient amounts of the active ingredient and result from negligent, but unintentional, errors in factory production. It’s an important difference as the root causes and solutions differ.
Resistance to antimalarials is growing in the region. Are fake or substandard drugs the cause? When taken on their own, fakes, which contain none of the active ingredient, will not risk resistance: there is no drug for any resistant parasites to survive attack from and then multiply. But if the antimalarial contains low amounts of active ingredient, susceptible parasites in the blood are killed but resistant ones multiply – and then are sucked up by mosquitoes to spread. The Greater Mekong area is now the epicentre for resistance to the most potent drug, artemisinin, and there are concerns this could spread to Africa, costing millions of lives. What other factors drive drug resistance? There are many: patients not taking full courses at the correct doses, availability of antimalarials over the counter and patients taking a single drug instead of a combined therapy. The World Health Organization recommends that artemisinin always be given with another antimalarial in the same tablet. The artemisinin kills most parasites in the first three days of treatment, then the partner drug eliminates the rest. How do you get fake drugs off the market? The steps that have been taken are woefully inadequate. The WHO estimated that 30 per cent of countries have effectively no drug regulation, and many of these have endemic malaria. Without functioning regulatory authorities, most interventions are doomed. To improve the quality of our medicine supply, we need much more international political will, backed by investment. Interview by Curtis Abraham
11 October 2014 | NewScientist | 31