New York Times: Profits on Cosmetic Save a Cure for Sleeping Sickness
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By DONALD G. McNEIL Jr.
February 9, 2001
PARIS, Feb. 8 - A cure for sleeping sickness, a disease devastating
parts of central Africa, may soon be available cheaply because it has
a second, profitable use: it eliminates facial hair in women. The
drug, eflornithine, is so effective at reviving even comatose pa-
tients that it is known as the resurrection drug. The Bristol-Myers
Squibb Company and the Gillette Company have just introduced eflor-
nithine in a facial cream, Vaniqa, and Bristol-Myers is close to an
agreement with the World Health Organization and the medical charity
Doctors Without Borders for the companies to make an injectable form
to treat human African trypanosomiasis, better known as sleeping
sickness. The disease, spread by the bite of the tsetse fly, drives
victims mad before killing them. It was nearly conquered in colonial
times but has again become epidemic in war-torn central Africa; about
300,000 people are infected each year. It has been known for more
than 10 years that eflornithine is a virtual miracle cure for try-
panosomiasis, but stocks have run out because early hopes that it
would help fight cancer have been dashed and medical production has
stopped. The last 1,000 doses, held by Doctors Without Borders, could
be used by June. The shortage is cited by critics of the industry who
say multinational drugcompanies ignore the poor.
Now production of eflornithine is resuming as an ingredient in the
face cream. And if the talks succeed, Bristol- Myers, with the help
of the Dow Chemical Company, Akorn Manufacturing Inc. in Decatur,
Ill., and Aventis, a French-German company that holds the basic pat-
ents to the drug, will make 60,000 medical doses by June and donate
them. "We're very happy and very grateful for this," said Felix Ku-
zoe, a consultant on sleeping sickness to W.H.O. "We approached Bris-
tol-Myers in November, and they gave us a very welcome reception and
had an answer for us in two months."
There is only one other treatment for the late stage of the disease:
melarsoprol, a caustic arsenic compound invented 70 years ago. Melar-
soprol kills 5 percent of those treated and damages the veins of oth-
ers; in addition, resistance to it is growing, so the long and pain-
ful treatment is sometimes ineffective. Until recently, eflornithine
was made only by an American subsidiary of Aventis, which ended pro-
duction in 1999 when the drug turned out to be useless against can-
cer, the intended target. (Coincidentally, another Aventis subsidiary
makes melarsoprol and a third makes pentamidine, which is useful
against early stages of the disease.) Bristol-Myers, W.H.O. and Doc-
tors Without Borders are very near agreement on a supply of the drug,
participants from all three said. The companies have offered to do-
nate three years' doses and then calculate a sales price for more;
Doctors Without Borders is asking instead for a guaranteed supply at
$10 a dose.
"We don't want to find ourselves in three years in the same position
we are in now," said Daniel Berman, a co-director of the agency's
campaign to get affordable life-saving drugs to poor countries. A
typical course treatment is an injection a day for seven days, for a
cost of about $70. The companies are hesitating to guarantee a long-
term price because bulk eflornithine is corrosive and destroys the
equipment used to make it, and the process used to make the in-
jectable form is slightly different from that used to make the cream,
meaning manufacturing costs will increase. "You can't just squeeze it
into a syringe," said Robert Laverty, a Bristol-Myers spokesman. But
Bristol-Myers and Gillette could make large profits on Vaniqa. A 30-
gram tube, about a month's supply for the removal of facial hair,
costs $54 at a Rite-Aid drugstore in Manhattan.
The two companies' development costs presumably have been relatively
low because the drug was first developed at the Merrell International
Research Center in Strasbourg, France, in the 1970's and preliminary
testing was done by other companies. Its usefulness in treating
sleeping sickness was discovered in 1979.
Bristol-Myers and Gillette have begun big advertising campaigns for
Vaniqa, which is sold by prescription. A six-page supplement to the
January issue of Cosmopolitan begins with pictures of three gorgeous
women with hairless lips and the words: "If the mustache that pre-
vents you from getting close is yours (not his), it may be time for a
beauty about-face. Millions of women like yourself battle unwanted
facial hair." Eflornithine suppresses the enzyme that causes facial
hair to grow, a discovery five years ago that was largely serendipi-
tous, as many drug uses are. A spokeswoman for Cosmopolitan declined
to say what the ad cost. For sleeping sickness, eflornithine is the
only drug besides melarsoprol that is able to kill the parasite try-
panosome after it has invaded the brain. The giant American and Euro-
pean pharmaceutical companies have come under intense fire in recent
years not only for the high prices of prescription drugs, but for ig-
noring diseases, like sleeping sickness and malaria, that affect only
the poor.
They are accused of ignoring research on diseases that kill Africans,
Asians and South Americans while concentrating their resources on
finding treatments for "lifestyle ailments" like impotence, baldness,
obesity (and facial hair) for customers in North America, Europe and
Japan who are, in dollar terms, 80 percent of the world's pharmaceu-
tical market. Eflornithine represents a case where it may be possible
to serve both interests at once. "What we're trying to do is help
them find a source of supply so this will never be a question again,"
Mr. Laverty said, referring to the W.H.O. and Doctors Without Bor-
ders. "The question is how this will be funded indefinitely." He de-
clined to say how much Bristol-Myers expected to earn from Vaniqa or
whether it hopes to sell future doses of injectable eflornitine at
cost or at a profit.
Copyright 2001 The New York Times Company
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