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      Improving Access to Medicines in Poor Countries: The Role of Universities

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      PLoS Medicine
      Public Library of Science

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          Abstract

          Universities Allied for Essential Medicines, a coalition of students and faculty across North America, focuses on how academic research institutions can help to improve access to essential medicines.

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          Most cited references20

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          Drug development for neglected diseases: a deficient market and a public-health policy failure.

          There is a lack of effective, safe, and affordable pharmaceuticals to control infectious diseases that cause high mortality and morbidity among poor people in the developing world. We analysed outcomes of pharmaceutical research and development over the past 25 years, and reviewed current public and private initiatives aimed at correcting the imbalance in research and development that leaves diseases that occur predominantly in the developing world largely unaddressed. We compiled data by searches of Medline and databases of the US Food and Drug Administration and the European Agency for the Evaluation of Medicinal Products, and reviewed current public and private initiatives through an analysis of recently published studies. We found that, of 1393 new chemical entities marketed between 1975 and 1999, only 16 were for tropical diseases and tuberculosis. There is a 13-fold greater chance of a drug being brought to market for central-nervous-system disorders or cancer than for a neglected disease. The pharmaceutical industry argues that research and development is too costly and risky to invest in low-return neglected diseases, and public and private initiatives have tried to overcome this market limitation through incentive packages and public-private partnerships. The lack of drug research and development for "non-profitable" infectious diseases will require new strategies. No sustainable solution will result for diseases that predominantly affect poor people in the South without the establishment of an international pharmaceutical policy for all neglected diseases. Private-sector research obligations should be explored, and a public-sector not-for-profit research and development capacity promoted.
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            Financial anatomy of biomedical research.

            Public and private financial support of biomedical research have increased over the past decade. Few comprehensive analyses of the sources and uses of funds are available. This results in inadequate information on which to base investment decisions because not all sources allow equal latitude to explore hypotheses having scientific or clinical importance and creates a barrier to judging the value of research to society. To quantify funding trends from 1994 to 2004 of basic, translational, and clinical biomedical research by principal sponsors based in the United States. Publicly available data were compiled for the federal, state, and local governments; foundations; charities; universities; and industry. Proprietary (by subscription but openly available) databases were used to supplement public sources. Total actual research spending, growth rates, and type of research with inflation adjustment. Biomedical research funding increased from 37.1 billion dollars in 1994 to 94.3 billion dollars in 2003 and doubled when adjusted for inflation. Principal research sponsors in 2003 were industry (57%) and the National Institutes of Health (28%). Relative proportions from all public and private sources did not change. Industry sponsorship of clinical trials increased from 4.0 dollars to 14.2 billion dollars (in real terms) while federal proportions devoted to basic and applied research were unchanged. The United States spent an estimated 5.6% of its total health expenditures on biomedical research, more than any other country, but less than 0.1% for health services research. From an economic perspective, biotechnology and medical device companies were most productive, as measured by new diagnostic and therapeutic devices per dollar of research and development cost. Productivity declined for new pharmaceuticals. Enhancing research productivity and evaluation of benefit are pressing challenges, requiring (1) more effective translation of basic scientific knowledge to clinical application; (2) critical appraisal of rapidly moving scientific areas to guide investment where clinical need is greatest, not only where commercial opportunity is currently perceived; and (3) more specific information about sources and uses of research funds than is generally available to allow informed investment decisions. Responsibility falls on industry, government, and foundations to bring these changes about with a longer-term view of research value.
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              Scaling up antiretroviral therapy in resource-limited settings: treatment guidelines for a public health approach

              (2003)
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                Author and article information

                Journal
                PLoS Med
                pmed
                PLoS Medicine
                Public Library of Science (San Francisco, USA )
                1549-1277
                1549-1676
                June 2006
                18 April 2006
                : 3
                : 6
                : e136
                Author notes

                Competing Interests: The Ford Foundation had no role in writing this article. The author declares that he has no competing interests.

                Dave A. Chokshi is a medical student at the University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, United States of America, and is part of Universities Allied for Essential Medicines. E-mail: daveash@ 123456med.upenn.edu

                Article
                05-PLME-SF-0631R1
                10.1371/journal.pmed.0030136
                1435781
                16608382
                d0a7fe49-7955-4f1a-b656-a65e0bd36462
                Copyright: © 2006 Dave A. Chokshi. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
                History
                Categories
                Student Forum
                Bioethics
                Infectious Diseases
                Other
                Science Policy
                Epidemiology/Public Health
                Health Economics
                Health Policy
                HIV/AIDS
                General Medicine
                Infectious Diseases
                Medicine in Developing Countries
                HIV Infection/AIDS
                Public Health
                Health Policy

                Medicine
                Medicine

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