Millions of children die needlessly
Nearly 11 million under age 5 succumb each year, largely to easily preventable illnesses, health experts say.
By EMMA ROSS
The Associated Press
LONDON – The lives of 6 million children under 5 could be saved every year if flu shots and other low-cost measures to prevent or treat disease were more widely used, global health experts say.
Every year, nearly 11 million children worldwide die before their fifth birthdays, most from preventable causes such as diarrhea, pneumonia, neonatal problems and malaria.
Malnutrition is a major factor in more than
half those deaths, researchers estimate.
In a series of articles this week in The Lancet medical journal, experts say inexpensive lifesaving measures - such as breast feeding, insecticide-treated bed nets, flu shots, antibiotics, newborn resuscitation and clean childbirth - are not reaching the mothers and children who need them most.
Scaling up those interventions to a level that would save 6 million lives a year would cost about $7.5 billion annually, the experts say.
In the 1980s, the world made great progress in reducing unnecessary child deaths through a UNICEF campaign called the child-survival revolution.
But the momentum was lost in the 1990s.
"We have dropped the ball," said one of the experts, Cesar Victora, professor of epidemiology at the Federal University of Pelotas in Brazil.
"Child survival has fallen off the international agenda. We need now a second revolution to finish this job."
The number of deaths among children under 5 fell from 117 per 1,000 live births in 1980 to 93 per 1,000 in 1990. Today, the death rate is still
declining but not as quickly - in 2000, it was 83 per 1,000.
Experts stressed two main reasons why progress appears to have stalled.
In the 1990s that HIV/AIDS shifted the world's attention and resources toward fighting that specific 'diseases'.
"I'm not saying that it was wrong (well I am), but child health lost out in that," said Hans Troedsson, director of child and adolescent health and development at the World Health Organization.
The experts noted that the total number of child deaths each year is greater than deaths due to HIV, malaria and tuberculosis combined.
The other major factor was complacency, experts say.
"We were doing really well," Troedsson said. "There was a kind of attitude that the job was more or less finished. That kind of perception meant that a lot of investments and commitments to keep the steam in child survival was actually lost."
Other experts said the death of former UNICEF leader Jim Grant, who spearheaded the child-survival revolution of the 1980s, left a void in
global leadership as UNICEF's focus shifted toward children's rights and education.
The U.N. children's agency said it still spends most of its money on child-survival programs and that many of its newer strategies addressing
children's rights and education translate in the long term to better child survival.
"The easy gains have been made," said UNICEF spokeswoman Marjorie Newman-Williams. "We have now plateaued because the strategies we have to put in place are more difficult."
Whereas earlier strategies were focused on delivering vaccines and medicines to clinics, future progress does not necessarily depend on that, she said. The benefits of that approach have been mostly mined, she said.
Many of the actions that will reduce the deaths now are those that have to be taken into the home, such as breast-feeding, bed nets and proper infant nutrition after weaning.
"Those three heavily depend on women's time, women's knowledge and availability," Newman-Williams said. "And to reduce neonatal mortality, you have to focus on women's health. This is not a child health intervention."
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http://wid.ap.org/science/royalties.html Two top scientists - Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, and his deputy, H. Clifford Lane - are among 916 government researchers who have been receiving royalties on experimental drug treatments without disclosing those royalties on their annual ethics forms or on experimental patient consent forms.
The practice is legal, though NIH says it has now
drafted a policy to require disclosure.
Health officials say the current and former employees are collecting royalties on drugs or medical inventions they developed while working for the government. The royalties are paid by drugmakers licensed to
produce the drugs. Some $8.9 million in royalties was paid to government-employed drug inventors in 2004; the average royalty per inventor was $9,700.
Below is an example of royalties received by Fauci and Lane on the interleukin-2 AIDS regimen, an experimental treatment for patients with HIV that they invented. Fauci has said he donates all his royalties to
charity, while Lane has opted to keep his.
Royalties Paid on Interleukin-2 AIDS Regimen Since 1997
Fauci Lane
1997 $23,606.13 $23,606.13
1998 $3,066.67 $3,066.67
1999 $3,066.67 $3,066.67
2000 $3,066.67 $3,066.67
2001 $3,066.67 $3,066.66
2002 $3,066.67 $3,066.66
2003 $3,066.67 $3,066.66
2004 $3,066.67 $3,066.66
Source: National Institutes of Health
Feds Failed to Disclose Financial Interest
JOHN SOLOMON
Associated Press
WASHINGTON - Government scientists have collected millions of dollars in royalties for experimental treatments without having to tell patients testing the treatments that the researchers' had a financial
connection, according to documents and interviews.
The personal royalties are legal, though the researchers developed the treatments at government expense. But the Health and Human Services
Department promised in May 2000 that scientists' financial stakes would be disclosed to patients, a pledge that followed an uproar over
conflicts of interest and mistakes in federal experiments.
The National Institutes of Health says it didn't implement a policy to order the disclosure until last week, shortly after The Associated
Press filed a Freedom of Information Act request.
"Quite frankly, we should have done it more quickly. But as soon as Director (Elias A.) Zerhouni found out about it, he ordered it done immediately," NIH spokesman John Burklow said.
The nearly five-year delay means hundreds, perhaps thousands, of patients in NIH experiments made decisions to participate in experiments that often carry risks without full knowledge about the researchers' financial interests.
"It's hard for patients to make an informed decision when they don't have all the information," said Bill Allison of the Center for Public Integrity, which monitors the ethics of government employees.
"When a doctor says, 'Here, try this experiment, it is safe, or it will help,' and the patient isn't aware he has a financial interest in the outcome of that treatment, it in essence is taking advantage of someone
by not letting them have all the information," Allison said.
In all, 916 current and former NIH researchers are receiving royalty payments for drugs and other inventions they developed while working
for the government, according to information obtained by AP. They can collect up to $150,000 each a year, but the average is about $9,700, officials said.
In 2004, these researchers collected a total of $8.9 million. Only a dozen received the legal maximum.
The government owns the patents and the scientists are listed as inventors so they can share in licensing deals struck with private manufacturers. In addition to the inventors' take, the government received $55.9 million in royalties for the same inventions and put
that money back into research.
The arrangements can create concerns about conflicts.
For instance, two top managers in NIH's infectious disease division have received tens of thousands of dollars in royalties for an experimental AIDS treatment they invented. At the same time, their office has spent millions in tax dollars to test the treatment on
patients across the globe, the records show.
Such research helps bring the treatment closer to possible commercial use, which could in turn bring the researchers and NIH higher royalties.
Except for patent records and scientific journals, the patients have had no easy way of learning about the researchers' financial stakes.
That's because NIH told doctors not to report royalties on their government ethics disclosure forms and did not require the royalties listed on patient consent forms until last week's policy.
Fifty-one NIH royalty recipients are currently involved in clinical research involving the inventions for which they are being paid, meaning they'll be affected by the new policy, according to the information obtained by AP.
Among them are National Institute of Allergy and Infectious Diseases Director Anthony Fauci and his deputy, H. Clifford Lane.
The two managers have received $45,072.82 each in royalties since 1997 for an experimental AIDS treatment known as interleukin-2 that they invented with a third NIH doctor, Joseph Kovacs, the records show.
The government has licensed the commercial rights to that treatment to drug maker Chiron Corp., and Fauci's division subsequently has spent $36 million in taxpayer money testing the treatment on patients in one
experiment alone.
Known as the Esprit experiment, it is one of the largest AIDS research projects in NIH history, testing interleukin-2 on patients at more than
200 sites in 18 countries over the last five years.
Both doctors said they were extremely sensitive about the possibility of an appearance of a conflict of interest and took steps on their own to address it even as they waited for their agency to do what they believed should have been done all along - fully disclose the payments
to patients.
A panel of peers from the National Cancer Institute was brought in to approve the Esprit project because Fauci and Lane were in a position to profit.
Fauci, an internationally known expert on illnesses from the flu to AIDS, said he originally refused to take the royalties but was told he legally had to accept them. So he has donated all the money to charity.
"I'm going to give every penny of it to charity ... no matter what the yearly amount is," he said.
Fauci also said he once tried to report his payments on his federal financial disclosure report, which is available to the public, but was told to remove them because NIH considers the money federal
compensation, not outside income.
Lane keeps his royalties but said he occasionally gave patients scientific journal articles that noted he was listed on the patent for interleukin-2. "I believe patients should know everything that might influence their desire to be participants in research," Lane said.
Both acknowledged they were unwilling to tell interleukin-2 patients about the royalties on consent forms until NIH developed its policy.
Both will do so from now on.
"We were reluctant to make a formal policy until the broad policy came down from the department and NIH," Fauci explained.
Their case illustrates the gulf between what the government promised nearly five years ago in the midst of controversy and what actually has been done.
Then-Health and Human Services Secretary Donna Shalala pledged in May 2000 that the government would develop policies to require "that any
researchers' financial interest in a clinical trial be disclosed to potential participants."
Congress, concerned by reports of conflicts of interest and researchers' conduct in several high profile experiments, was told the changes would happen. The government first published guidance for the
disclosure in January 2001.
Current HHS Secretary Tommy G. Thompson issued new guidance this May that again clearly cited "compensation that may be affected by the study outcome" and "proprietary interests in the products, including patents, trademarks, copyrights or licensing arrangements."
NIH, however, didn't order the disclosure until last week's policy.
ON THE NET
Documents:
http://wid.ap.org/science/royalties.html National Institutes of Health:
http://www.nih.gov