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It follows quite naturally, a deadly parasitic disease and facial hair growth treated with the same medicine, doesn’t it? Uh, no.
When the cream for feminine facial hirsutism (unnatural hairy growth), was first released, I looked it up (in a book, would you believe?), and read about its use intravenously for trypanosomiasis. Not able to make the relation compute (I can’t make much compute on a computer), I called the manufacturer, Bristol-Myers Squibb. The research person told me of its use in chemotherapy for cancers — where it never really found a place — and the observed hair loss during therapy. This led to the cross-pollination of ideas from cancer and infection to hair suppression.
In the November 2001 Journal of the American Academy of Dermatology, Philip Coyne Jr., M.D., of the U.S. Public Health Service and Walter Reed Hospital, wrote an elegant narrative of the relationship. Eflornithine, chemically difluoromethylornithine or DFMO, was synthesized in the 1970s as a possible anticancer drug. It inhibits ornithine decarboxylase, a key enzyme in making polyamines, resulting in a consequent impairment of cell division. A parasite biochemist, Cyrus Bacchi, learned of it, and studied it in mice infected with sleeping sickness. The dramatic results in these critters spurred human trials organized by the Word Health Organization in Sudan. The dramatic human responses of some comatose patients led to its nickname, “the resurrection drug.”
Other options for treating sleeping sickness date from 1920. Suramin is still used now but was developed in Germany after World War I. Melarsoprol, an organic arsenic compound for late-stage disease, is from 1932. Another early-stage drug used for many parasites is pentamidine, from 1937. The WHO estimates about 60 million people in sub-Saharan countries are at risk for infection, with about 300,000 new cases a year.
Using these medicines is problematic because of poverty, poor resources, remoteness, the need for intravenous administration and expense. Eflornithine’s cost for a 14-day intravenous course is $600 to $800. In countries where per capita annual spending of health care is as little as $10 or less, drug companies cannot make any money.
The company Marion Merrell Dow first manufactured eflornithine with “orphan drug” status, and agreed to supply it to the WHO at cost, with the expectation that another company would take it over. As the company was about to quit making it, it merged with another drug company and formed Aventis, but quit manufacturing it because it is resource intensive and highly corrosive (and not profitable). In 2001 the WHO and Doctors without Borders, a humanitarian group based in France but working around the world, lobbied Aventis to continue making the drug. A five-year agreement was made to make enough to cover existing needs, the annual donated cost at about $5 million. Bristol-Myers Squibb also has paid for part of the cost of drug, selling it as Vaniqa.
The now Sanofi-Aventis, after another two-company merger, is waiting to hand off production of DFMO because it is not cost-effective. It is partly the development of the hair removal market that encouraged Aventis to restart production of DFMO, allowing it, once again, to become available to save lives from sleeping sickness.
It is kind of a paradoxical (not two doctors) feeling to realize that, as a dermatologist, when I write a prescription (or send it through a computer in the “new” world) for a medicine to slow undesirable hair growth, I am supporting the availability and implementation of the same medicine to save someone’s life in a completely different part of the world.
