Stephen Leahy
BROOKLIN, Canada, Sep 22 2006 (IPS) – Hi-tech medicine, including stem cell therapy and biotechnology, are seen by many experts as potential solutions for non-infectious diseases like diabetes in the developing world.
Eliminating the need for costly insulin injections for diabetics, regenerating heart muscle after it fails, and improving resistance to disease by engineering immune cells top a list of 10 areas developing countries should focus their medical research on, say experts from the North and South.
Developing countries could potentially benefit from advances in regenerative medicine to address the epidemic of non-communicable disease and other pressing health needs, says a study by the University of Toronto published recently in the journal Public Library of Science (PLoS) Medicine.
Regenerative medicine involves the repair, replacement or regeneration of cells, tissues or organs impaired by congenital defects, disease, trauma and other causes. It moves beyond traditional transplant and replacement therapies to include the use of stem cells, soluble molecules, genetic engineering, tissue engineering and advanced cell therapy.
We were looking at ways that developing countries can harness the life sciences, said co-author Abdallah Daar, director of ethics and policy at Toronto s McLaughlin Centre for Molecular Medicine.
And by identifying the top potential applications in the study, developed countries can better target their aid, Daar told IPS.
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As with many other health technologies, for example, vaccines, it is people in the developing world, where 90 percent of humankind lives, who may ultimately derive the most benefit, he said.
First on the list of hoped-for new technologies in the study was novel methods of insulin replacement and pancreatic islet cell regeneration for diabetes . Such methods include biotechnology and stem cell therapies.
Diabetes is a huge health care burden for developing countries and insulin is expensive, so regenerative medical breakthroughs could dramatically reduce that burden. That is why the international panel of experts made it their first choice, said co-author Heather Greenwood of the Canadian Programme on Genomics and Global Health.
Over 75 percent of our 44 experts came from developing countries, Greenwood said in an interview.
When it comes to health issues, the donor community, including major funders like the Gates Foundation s Grand Challenges initiative, has been focused on infectious diseases while non-communicable diseases have been ignored, she said.
However, the pattern of disease is changing in developing countries from infectious diseases to non-communicable diseases as the major causes of death and disability.
According to the World Health Organisation (WHO), by the year 2020, non-communicable diseases such as cancer, heart disease and mental illness will make up 60 percent of the disease burden in developing countries. Urbanisation, rapid industrial development and aging populations associated with increases in life expectancy account for much of this change.
Still, not everyone is convinced that the answer lies in new technologies. My guess is regenerative medical technologies would not be the first choice to solve these problems, said Ramanan Laxminarayan, a senior fellow at Resources for the Future, a global issues think tank in Washington.
Laxminarayan worked on the Disease Control Priorities Project, a four-year effort by the U.S. National Institutes of Health, the WHO and the World Bank to find ways to deal with health problems in poor and middle-income countries.
A report from the project compiling and prioritising an exhaustive list of 320 health-improving strategies based on advice from nearly 500 world experts was published in the medical journal the Lancet last spring.
None of those interventions involved stem cell therapies, Laxminarayan told IPS.
Most of the regenerative technologies in the PLoS study are so far off in the future, he said, adding that if better screening tests for diseases or cheaper vaccines could be developed, then they might be worth pursuing.
Daar points out that India can now make insulin from bioengineered bacteria at a much lower cost, and it also makes a much cheaper Hepatitis B vaccine.
Health biotechnology and regenerative medicine appear expensive at first but can end up being cheaper in the long run, he noted. The more R D developing countries do themselves, the more affordable these technologies will be.
And that is starting to happen, especially in India and China, he said.
India s non-profit L.V. Prasad Eye Institute has used adult stem cell therapy to repair the corneas of over 260 blind patients, while the Centre for Cellular and Molecular Biology in the province of Hyperabad is trying to grow pancreatic beta cells to treat diabetes.
The hope is to spread these technologies to other developing countries, said Daar.
Developing, testing and use of these new technologies will require careful safety and ethical guidelines, everyone acknowledges.
India has the most advanced stem cell research guidelines in the world, Daar explained.
Laxminarayan agrees, but says such guidelines are not always applied nor enforced.
There are lots of examples in India of pharmaceutical drug testing that didn t follow guidelines and nothing has been done, he said.
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