Nitze Fellow Explores Medical Innovation

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Sophie Delaunay, the U.S. Director of Doctors Without Borders/Médecins Sans Frontières (MSF),  returned to St. Mary’s Hall on the evening of Feb. 8 to deliver her second lecture as the Nitze Senior Fellow for 2011-2012.

The lecture, titled “Medical Innovations in Humanitarian Situations,” detailed MSF’s role as a pioneering organization, not just in the field of medical humanitarianism, but also in pharmaceutical development. MSF sends teams of volunteer medical staff  into more than 60 countries, which are home to those who “are threatened by armed conflict, epidemics, malnutrition, exclusion from healthcare, and natural disasters,” according to the lecture’s program.

Michael Taber, assistant professor of Philosophy and Director of the Nitze Scholars Program, introduced the lecture by drawing a comparison between the innovation of St. Mary’s as a “unique public honors college,” which provides a high quality education at a public school price, and MSF’s similar goal of administering first-world healthcare to third-world countries.

The settings in which MSF functions are often dangerous and removed from the medical conveniences of developed nations. “MSF’s professional specialization is innovation,” Delaunay said, “because the emergencies in which we [are] operating [are] non-specialized.”

Delaunay provided an anecdote to explain how MSF donors perceive the organization as in need of medicine donations, as opposed to monetary ones. “People think charity medicine is outdated and secondhand, and that we’re always on the verge of being abandoned,” she said. “One donor wanted to give us medicine for cancer,  and another woman who was scheduled for liposuction offered us her fat to use in surgeries.”

These propositions were declined because MSF only accepts monetary donations, Delaunay explained, and said that in reality, MSF participates in “medical innovation in the developed world as well as the third world,” eliminating the need for donations of actual medicine.

Delaunay detailed how many MSF branches, based in different areas of expertise, were developed to help the organization run more efficiently.

When MSF organizers realized that certain teams were struggling to operate safely in their given conditions, a medical department was created to oversee the development of medical tool kits made specifically for different diseases. “You wouldn’t think MSF would need a medical department, because they were all doctors, but it was necessary to have a specialized team to make operations go smoothly.”

The MSF satellite organization, Logistique, was created “to be in charge of supplying MSF outposts with medicine and tools,” said Delaunay. She also spoke about Epicentre, another independently-operated branch,  which “changed the rules of how drugs were prescribed and produced” while becoming MSF’s own epidemiological center to study the treatment of diseases.

Delaunay’s first assignment with MSF was in Thailand, a relatively stable country sheltering an influx of refugees from neighboring countries such as Vietnam and Cambodia. Amongst these refugees, malaria, a mosquito-borne disease, was the main cause of death. The refugees were quickly becoming resistant to the drugs used to treat malaria, a problem that made death almost certain for malaria patients.

“One MSF doctor was so frustrated by the proliferation of the disease,” said Delaunay, “that he decided to study malaria with the help of universities in Thailand and England.” This research eventually led to the discovery of an effective artemisinin-based drug used in Chinese medicine.

Chinese researchers studied the drug, but “Chinese drugs were not studied to international science standards,” said Delaunay. In addition, pharmaceutical companies could not expect a monopoly or profit from producing such a drug, which was to treat a disease that  was all but obsolete in the developed world. Delaunay also admitted that some officials were reluctant to recognize that something as uncommon as Chinese medicine had found the solution for malaria.

The World Health Organization and other academic institutions had no plans to study artemisinin, so MSF took it upon itself to do so. “A few ethical dilemmas were created by this decision,” said Delaunay. “Studies conducted among Burmese refugees were done under informal consent, meaning that the test subject’s choice of participation was made independently because the organization conducting the study is also providing them with medical assistance, and he would feel obligated to participate.”

“There were also debates among MSF staff members,” Delaunay said, “about the practicality of continuing to use the old drugs on malaria patients when it was clearly not working.”

In the end, Epicentre conducted clinical trials in 18 countries with Western scientific standards and peer-review journals, and artemisinin drugs were produced by MSF’s Drugs for Neglected Diseases initiative (DNDi), an organization that “makes deals with pharmaceutical companies to research drugs that have not been used in a while,” said Delaunay.

Despite MSF’s accomplishments within medicine, Delaunay said, “Don’t think there isn’t a need for further innovation. The malaria conflict was a mix between effective treatment and political advocacy. If we lack either, our policies are asked to change. When we have the right treatment, political will happens within the interests of major states.”

Delaunay concluded the lecture by saying, “Humanitarian medicine is by no means second-class. Our doctors have worked consecutive hospital jobs prior to joining MSF. Just because we have poor patients does not mean they are given poor doctors. Humanitarian players are ready to change the status quo.”

Sophomore Colleen Hughes, who was required to read MSF’s book on medical innovations for a class in the Nitze Scholars Program, said, “I was able to get a better understanding of the subject I’ve been reading about for the past few weeks.”

Clara Richards, a sophomore aspiring to work in the field of medicine, found the lecture to be a supplement to her current schoolwork. “I did a project on malaria recently,” said Richards, “and it was very interesting to listen to someone who’s so knowledgeable about the disease and it’s treatments.”

Delaunay will give her third and final lecture as the Nitze Senior Fellow, entitled “Adapting to Recent Developments in Global Health,” on April 16 at 8 p.m. in St. Mary’s Hall.

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