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MASSIVE Tuberculosis News

2023-12-05 · letter vlog · John · 5:19 · watch on YouTube

Topic: Global development · mode: News analysis · tags: timely hook, heavy topic

John reports the endTB trial results: nine-month regimens of existing drugs cure multidrug-resistant TB as well as or better than the toxic 18-month standard at about $300 instead of $5,000, and argues that because drug companies lack incentive to test existing compounds in new combinations, such trials need far more public and philanthropic funding.

What is said

The parts of the video and what is said in each (★ — how much it matters to the video).

00:00:00 — A standing-ovation TB study; why TB needs antibiotic cocktails and how toxic, long and ineffective MDR-TB treatment has been

  • ★★ John says a couple of weeks ago a tuberculosis research study presented at a conference got a standing ovation. — 00:00:00
  • ★★★ John thinks the study matters not only for TB treatment but for how to speed up innovation in treating other diseases, from malaria to cancer. — 00:00:00 · tuberculosis, malaria, cancer
  • ★★ John explains that curing tuberculosis requires a cocktail of antibiotics because its bacterium, Mycobacterium tuberculosis, is notoriously hard to kill. — 00:00:00 · tuberculosis
  • ★★★ John says MDR-TB patients lucky enough to be treated face an 18-to-24-month regimen with injectables so toxic and painful a TB survivor likened them to injected lava, plus around 13,000 pills. — 00:00:29
  • ★★★ John says the pill burden, side effects and length make many patients unable to finish treatment, so they die; with most never diagnosed or treated, only around 10% of people with MDR-TB are cured. — 00:00:58

00:01:27 — The endTB trial: design, cure rates, safety and cost of the nine-month regimens, J&J's patents, and pressure on the WHO

  • ★★ John says a much better regimen of five pills a day emerged in recent years, but it is still relatively expensive, uses a drug not widely available in poor countries, and is not for children or pregnant people. — 00:01:27
  • ★★★ John says Partners In Health, Doctors Without Borders, Unitaid and others ran a randomized controlled trial over several years testing whether shorter regimens of existing drugs can cure MDR-TB. — 00:01:27 · Partners In Health
  • ★★★ John reports the trial compared the 18-month standard with five nine-month regimens in seven countries: three matched or slightly beat the standard, and one cured significantly more, around 90%. — 00:01:56
  • ★★ John says the two best regimens were also fairly safe and the least expensive: no toxic injectables, nine months instead of 18, better cure rates for less money. — 00:02:26
  • ★★★ John says the 18-month regimen costs about $5,000 per person, while the two best nine-month endTB regimens cost about $300. — 00:02:26
  • ★★ John says the low price is partly because Johnson & Johnson is not pursuing secondary patents on bedaquiline, which is in part thanks to Nerdfighteria. — 00:02:26 · Nerdfighteria
  • ★★ John hopes the WHO will soon recommend the new shorter regimens, meaning more people surviving MDR-TB and less MDR-TB in the world. (hedged) — 00:02:55
  • ★★ John warns that if the WHO does not recommend the new regimens quickly, he and other TB activists and survivors will be knocking on its door incessantly. — 00:02:55

00:03:24 — Drug companies lack incentive for trials of existing compounds; such trials, for TB and cancer, need much more funding

  • ★★★ John finds it most interesting that the trial used existing drugs in innovative combinations rather than proving a patentable billion-dollar compound, the kind of trial drug companies have little incentive to run. — 00:03:24
  • ★★ John says cancer treatment shows the same pattern: trials of new patentable compounds always have incentive, but testing existing compounds in new combinations or dosages is much harder to fund. — 00:03:24 · cancer
  • ★★★ John says 1.6 million people will die of TB this year (2023). — 00:03:53 · tuberculosis
  • ★★★ John says new drugs and drug classes are needed, but those dying this year (2023) cannot wait for them; they need drugs that exist now, and the endTB trial gives them hope. — 00:03:53 · tuberculosis
  • ★★★ John says such trials need better funding: public money and private donations have funded many in cancer but more is needed, and neglected diseases like TB need massive investment. — 00:04:22 · cancer, tuberculosis
  • ★★★ John says the endTB trials could have started a decade ago; finding these better, safer, faster and cheaper cures sooner would have spared much needless suffering and death. — 00:04:22
  • ★★★ John says the endTB trials will not make any individual a billion dollars, but will make all of humanity less poor and less sick. — 00:04:52

In the description and comments

  • ★ Answering a commenter, John says generic competition makes drugs cheaper with volume through economies of scale, so bedaquiline's price may keep falling as more people take it. (hedged) — creator comment
  • ★ In a comment John says many high-burden countries rely on WHO recommendations, which tend to come slower than some would like. — creator comment

Threads in this video

Where the stories that moved here went next

Mentioned

Central: endTB trial · multidrug-resistant tuberculosis · tuberculosis

Also: Organizations: Johnson & Johnson · Médecins Sans Frontières · Partners In Health · Unitaid · World Health Organization

Concepts: Antibiotic · cancer · evergreening · malaria · Mycobacterium tuberculosis · pharmaceutical industry · randomized controlled trial

Products: Bedaquiline

Only in the description or credits: economies of scale · generic drug

Also centred on multidrug-resistant tuberculosis: Barely Contained Rage: An Open Letter to Johnson & Johnson · Talking Tuberculosis, GeneXpert, J&J, and more with MY HEROES · End of a Rough Year · ITS ALL HAPPENING · Real Reasons for Hope

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