Press Release
For immediate release
Tuesday, March 7, 2006
9:00 a.m. EDT


Christopher Fleming

Super-Resistant Malaria Strains Likely Without Global Subsidies Of Critical New Therapies, According To New Study In Health Affairs

Premier Health Policy Journal Launches Comprehensive Initiative To Spotlight Global Health

Bethesda, MD — Subsidies for the costs of artemisinin-based combination treatments for malaria are needed immediately to prevent the emergence of a malaria superbug, finds a new study released today in the March/April 2006 issue of Health Affairs. It warns that failure to provide this support could allow the malaria parasite to become resistant to all known treatments, possibly by the end of the decade.

The malaria parasite already has defeated previously effective treatments, contributing to a global resurgence in malaria. Now there is fear that one of the most effective drugs ever developed for malaria, artemisinin, could suffer the same fate. Health experts have sought to avert a multi-drug resistant form of malaria by insisting that artemisinin be administered in combination with other malaria drugs. By presenting two drug targets instead of one, this tack frustrates the parasite’s ability to develop resistance. But in malaria-endemic countries, so-called “Artemisinin Combination Therapies,” or ACTs, are largely unaffordable.
What’s in the issue. The malaria study is one of several articles in the March/April issue,, offering insights into a range of policy options on global health dilemmas. These articles reflect the beginning of an aggressive, long-term initiative, funded by the Bill and Melinda Gates Foundation, to focus more attention on global health policy research.

As Health Affairs approaches its twenty-fifth anniversary, it is well positioned to “become a more active force” in global health issues, writes John K. Iglehart, founding editor of Health Affairs, in an editorial. He points out that the journal’s founder and publisher, Project HOPE, operates health programs around the world and that saving lives in poor countries is also central to the journal’s mission. “With the support of the Gates Foundation, we are eager to spotlight policy research that assists in the fight to improve global health,” Iglehart says. “Good policy is as important as good science for saving lives.”

Drug fast-track review proposal. Also in the March/April issue, David Ridley and colleagues offer a proposal to encourage drug companies to develop treatments for neglected diseases by offering “vouchers” that could be used to accelerate the U.S. Food and Drug Administration’s (FDA’s) review of a blockbuster drug intended primarily for rich-country markets. Such transferable priority-review vouchers would be a win-win benefit, offering “faster access to blockbuster drugs in developed countries and faster access to cures for infectious diseases in developing countries,” according to Ridley and colleagues at Duke University;

Should Americans seek treatment abroad? Other internationally oriented articles in the March/April issue focus primarily on the wealthier nations of the developed world. For instance, the World Bank’s Aaditya Mattoo argues that the failure of U.S. health insurance policies to cover care received abroad is preventing the substantial savings that could come with freer trade in health care. Mattoo and Randeep Rathindran of HDR/HLB Decision Economics say that savings could amount to $1.4 billion annually if only one in ten U.S. patients chose to receive treatment abroad for one of fifteen relatively straightforward procedures, such as knee surgeries, hysterectomies, and cataract extractions.

Does the U.S. face a physician shortage? On the domestic front, the March/April Health Affairs offers some challenges to conventional wisdom. For example, Dartmouth’s David Goodman and his colleagues question the new consensus that the United States faces an impending physician shortage. As evidence, Goodman and colleagues offer a threefold variation in the amount of physician care given to patients at different academic medical centers in the last six months of life. They write that this variation is related to regional variations in physician supply, rather than any effects on the well-being of the patient. They assert that we should use our resources on replicating the efficient care offered by interdisciplinary practices such as the Mayo Clinic, rather than training more physicians who will only generate increased costs for the health system.

Drug development costs. Salomeh Kehanyi and colleagues dispute the argument often made by the drug industry that longer drug development times are behind rising pharmaceutical prices. They present evidence that development times have generally been decreasing, and they say that drugs with potentially high sales took a year less to develop than other drugs. On the other hand, Christopher Adams and Van Branter of the Federal Trade Commission found the average cost of developing a new drug to be $868 million, slightly higher even than the much-debated $802 million estimate offered in 2003 by Joseph DiMasi and colleagues. However, the FTC authors also found wide variations in development costs, some attributable to strategic choices by drugmakers themselves.

Health care and the hurricanes of 2005. Finally, a special section of Narrative Matters titled “Witness to Disaster” tells first-person stories of the aftermath of the fall 2005 Gulf Coast hurricanes. Patients, local clinicians and officials, and volunteers who came from all over the country relate experiences that generally never made headlines but often made the difference between life and death. An online supplement updates what life in New Orleans is like in March 2006, as well as providing photographs of the destruction.

Health Affairs, published by Project HOPE, is a bimonthly multidisciplinary journal devoted to publishing the leading edge in health policy thought and research. Copies of the March/April 2006 issue will be provided free to interested members of the press. Address inquiries to Christopher Fleming at Health Affairs, 301-347-3944, or via e-mail, All articles are available online, a selection of which are available at no cost, at The public may order print editions of the March/April issue for $35 each from Health Affairs’ Customer Service at 301-347-3900 or online at