ARAB TIMES, TUESDAY, DECEMBER 29, 2009
Thai-Cambodia border disease epicenter
New form of malaria
renders drug useless
Once curable diseases such as feeding smugglers’ routes that snake
tuberculosis and malaria are rapid- through Myanmar and into Laos,
ly mutating into aggressive strains Thailand, Cambodia and Vietnam.
that resist drugs. The reason: The Counterfeits
misuse of the very drugs that were The counterfeits, along with outdat-
supposed to save us has built up ed drugs, are jumping continents. In
drug resistance worldwide. Second Africa, where malaria is endemic in 45
in a five-part series. — Editor countries, the fake drug industry is
❑ ❑ ❑ thriving. A 2003 World Health
By Margie Mason and Martha Organization survey found between 20
percent and 90 percent of antimalarials
Mendoza randomly purchased in seven African
countries failed quality testing,
O ’treng village does not look like
the epicenter of anything.
Just off a muddy, rutted-out road, it
depending on the type of drug.
WHO and Interpol formed a task
force three years ago to try to stop
is nothing more than a handful of counterfeiters, seizing millions of fake
Khmer-style bamboo huts perched malaria, tuberculosis, HIV and other
crookedly on stilts, tucked among a pills in Southeast Asia and Africa. But
tangle of cornfields once littered with officials say the work is only as good
deadly land mines. as the countries’ legal systems.
Yet this spot on the Thai-Cambodian “One of the problems is that there’s
border is home to a form of malaria not really any enforcement, so what
that keeps rendering one powerful drug happens when they find a drug that’s
after another useless. This time, scien- counterfeit or substandard?” says
tists have confirmed the first signs of David Sintasath, a regional epidemiol-
resistance to the only affordable treat- ogist at the nonprofit Malaria
ment left in the global medicine cabi- Consortium in Bangkok. “The policy is
net for malaria: Artemisinin. to take it away from them. That’s good A grower holds a marijuana plant under a grow-light, in Seattle. The marijuana is distributed to members of a cooperative of medical patients who have received doctor’s author-
If this drug should stop working, until the next month when they get ization to use the drug to treat their illness, such as AIDS and multiple sclerosis. Unlike several other states which permit marijuana sales to patients, Washington requires patients
there would be no good replacement to to grow marijuana themselves or designate a caregiver to grow it for them. (AP)
their next shipment, right?”
combat a disease that kills 1 million Countless unlicensed shops in
people annually. As a result, interna-
tional medical leaders declared this
Cambodia sell artesunate, a single- ‘Legalization may up health care costs’
drug therapy that has been banned in
year that resistant malaria here is a the country. Artesunate, a modified
States weigh marijuana reform
health emergency. version of artemisinin derived from a
“This is not business as usual. It’s Chinese herb, has been hailed as mira-
something really special, and it needs a cle treatment worldwide because it
real concerted effort,” said Dr. Nick works so well with so few side effects.
White, a malaria expert at Mahidol But Cambodian surveys have shown OLYMPIA, Washington, Dec 28, (AP): Bruce Mirken, spokesman for the themselves “if they believe we really will
University in Bangkok, who has spent that many patients take artesunate Washington is one of four states where Marijuana Policy Project, a Washington, make all that revenue, and even if we did,
decades trying to eradicate the disease alone instead of mixing it with another measures to legalize and regulate marijua- D.C.-based marijuana advocacy group. will it be worth the suffering, the loss of
from Southeast Asia. “We know that antimalarial drug, making it easier for na have been introduced, and about two “There are some parts of the country where opportunities, the chronic illness or death
children have been dying in Africa — resistance to build. dozen other states are considering bills social attitudes are just a little more cau- that would occur?”
millions of children have died over the “The drug has been around for a ranging from medical marijuana to decrim- tious and conservative.”
past three decades — and a lot of those Measure
long time and misused for a long time, inalizing possession of small amounts of Rep. Mary Lou Dickerson, a Seattle Legalization isn’t the only measure law-
deaths have been attributed to drug and this is all encouraging the parasite the herb. Democrat who is sponsoring the legaliza-
resistance. And we know that the drug makers across the country are weighing.
to develop resistance,” says Dr. Delia “In terms of state legislatures, this is far tion bill in Washington state, said that she About two dozen states, including
resistance came from the same place.” Bethell, of the U.S. Armed Forces and away the most active year that we’ve “wanted to start a strong conversation
Malaria is just one of the leading Pennsylvania, New Jersey and Wisconsin,
Research Institute of Medical Science, ever seen,” said Ethan Nadelmann, execu- about the pros and cons of legalizing mari- are considering bills ranging from medical
killer infectious diseases battling back whose research has been at the fore- tive director of the New York-based Drug juana.”
in a new and more deadly form, the AP marijuana to decriminalizing possession of
front of identifying emerging resist- Policy Alliance, which supports reforming Under her bill, marijuana would be sold small amounts of marijuana, St. Pierre
found in a six-month look at the soar- ance on the border. marijuana laws. in Washington state’s 160 state-run liquor
ing rates of drug resistance worldwide. said. Washington state is among the states
Back in western Cambodia a few Nadelmann said that while legalization stores, and customers, 21 and older, would that are considering decriminalization,
After decades of the overuse and mis- miles from O’treng village, shopkeep- efforts are not likely to get much traction in pay a tax of 15 percent per gram. The
use of antibiotics, diseases like malar- with a bill that would reclassify adult pos-
er Nop Chen turns a flashlight on a state capitals anytime soon, the fact that measure would dedicate most of the money session of marijuana from a crime with jail
ia, tuberculosis and staph have started glass case full of drugs he hawks from An immigrant from Mexico holds her four there is such an increase of activity “is ele- raised for substance abuse prevention and
to mutate. The result: The drugs are time to a civil infraction with a $100 penal-
inside his cramped roadside house. He day-old son during a newborn care class vating the level of public discourse on this treatment, which is facing potential cuts in ty.
slowly dying. digs through the many boxes and pro- at a community health center for low- issue and legitimizing it.” the state budget.
Resistance income patients in Aurora, Colorado. The Fourteen states, including Washington
duces two different types of “I would say that we are close to the tip- Dickerson said the measure could even- state, already have medical marijuana
Already, The Associated Press artemisinin-based antimalarials. Both Metro Community Provider Network ping point,” he said. “At this point they are tually bring in as much to state coffers as
(MCPN), which has 11 health centers in laws, and 13 have decriminalization laws
found, resistance to malaria has spread lack the full amount of a second still seen as symbolic bills to get the con- alcohol does, more than $300 million a on the books, St. Pierre said. About two
the Denver area, has seen a 138 percent
faster and wider than previously docu- required medication, mefloquine, nec- increase in patients during the last year of versation going, but at least the conversa- year. dozen cities across the country, including
mented. Dr. White said virtually every essary to treat the strain of malaria in recession. Non-profit community health tion can be a serious one.” Revenue Seattle, make marijuana offenses a low
case of malaria he sees in western the area and ward off more resistance. centers such as MCPN could play a major Opponents of relaxing marijuana laws “Our state is facing a huge financial law-enforcement priority.
Cambodia is now resistant to drugs. Cluster role nationally if health care reform is aren’t happy with any conversation on the deficit and deficits are projected for a few Marijuana advocates said that while
And in the Pailin area, patients given But Nop Chen, a former Khmer passed, with increased subsidies from topic, other than keeping the drug illegal. more years,” Dickerson said, referring to increased activity in the statehouse is
artemisinin take twice as long as those Rouge medic, points to a small the federal government as well as millions “There’s no upside to it in any manner
of newly-insured low-income citizens the projected $2.6 billion hole lawmakers heartening, change most likely will come
elsewhere to be clear of the parasite — Cambodian seal on the boxes and says other than for those people who want to will need to fill next year. “We need to look at the ballot box through voter-driven ini-
84 hours instead of the typical 48, and he feels confident the drugs are the real seeking care. Health coverage for immi-
grants remains a contentious issue in the smoke pot,” said Travis Kuykendall, head at revenue and see what might be possi- tiatives.
sometimes even 96. deal. Still, he acknowledges he is not reform debate. (AFP) of the West Texas High Intensity Drug- ble.” “Inevitably, the politicians are going to
Mosquitoes spread this resistant licensed to sell the pills and he is Trafficking Area office in El Paso, Texas. Allen St. Pierre, executive director of the be behind the curve on this stuff,”
malaria quickly from shack to shack, unsure where they originated. “There’s nothing for society in it, there’s National Organization for the Reform of Nadelmann said, noting that almost all of
village to village, eventually country to “I’m not concerned because it’s got nothing good for the country in it, there’s Marijuana Laws, said that tough economic the medical marijuana laws came about by
country. the sticker and the stamp,” he says, nothing for the good of the economy in it.” times across the country have lawmakers initiative.
And so O’treng, with its 45 poor squinting at the Khmer script on the Prosecution looking at everything, and may lead even This month, a group campaigning to put
families, naked kids, skinny dogs and labels. “Because of the logo, I trust it to Legalization bills were introduced in more states to eventually consider the a marijuana legalization measure before
boiling pots of rice, finds itself at the not be fake; it was made in Cambodia.” California and Massachusetts earlier this potential tax value of pot. California voters said it had enough signa-
epicenter of an increasingly desperate year, and this month, New Hampshire and “The bean counters are now reporting tures to qualify for the 2010 ballot.
worldwide effort to stop a dangerous Walk past O’treng’s cluster of sag- Washington state prefiled bills in advance back to their elected officials how much That proposal would legalize possession
new version of an old disease. ging huts, cross another cornfield and of their legislative sessions that begin in money is being left off the table,” he said, of up to one ounce of marijuana for adults
hike a twisted mile (1= kilometer) on a January. Marijuana is illegal under federal adding that billions of dollars worth of pot 21 and older. Residents could cultivate
Bundled in a threadbare batik dirt track to a wooden shack where a law, but guidelines have been loosened on is going untaxed. marijuana gardens up to 25 square feet (2.3
sarong, 51-year-old Chhien Rern, one string of smoke is curling through the federal prosecution of medical marijuana Ron Brooks, president of the National sq. meters). City and county governments
of O’treng’s sick residents, sweats and wooden floor planks in a largely futile Schiff Frieden
under the Obama administration. Narcotics Officers’ Associations’ would determine whether to permit and tax
shivers as a 103-degree fever rages effort to keep mosquitoes away. It is Even so, marijuana reform legislation Coalition, said that he feared that, if legal- marijuana sales within their boundaries.
against the malaria parasites in her here that skinny 13-year-old Hoeun remains a tough sell in some places. In the ized, marijuana would contribute to more And in Nevada earlier this month, backers
bloodstream. Hong Da wakes up on the floor nau- Health South, for example, only Mississippi and highway accidents and deaths, as well as a of a move to legalize marijuana there filed
Three days ago Chhien Rern started seous and burning with fever. North Carolina have decriminalization potential increase in health care costs for paperwork creating an advocacy group
feeling ill while looking for work in a Hong Da recovered from malaria laws on the books. those who smoke it. aimed at qualifying an initiative for the
neighboring district. So she did what two months ago, but now the dizziness Airbags not risk in pregnancy: For “It’s a social and cultural thing,” said State lawmakers, he said, need to ask 2012 election.
most rural Cambodians do: She walked and headaches are back. He has been pregnant women involved in a traffic accident,
to a little shop and asked for malaria sickened by the disease six or seven the impact of an airbag does not seem to raise
medicine. With no prescription, she times in his short life — too many to the risks of most pregnancy complications, a 10 percent among women in crashes where no weekly bulletin on illness and death. These The biggest percentage of deaths was among
was handed a packet of pills; she is remember. He knows that if he does new study finds. airbag deployed. (RTRS) overdose deaths have been on the rise nation- middle-aged people 45 to 54 years old, who
Airbags, used along with seatbelts, are ❑ ❑ ❑ wide since 1999. accounted for 34 percent of overdose deaths.
unsure what they were. not get to a hospital soon, he could die. known to cut car-crash victims’ risk of death
With no new treatments in the Most who OD took methadone: A recent To better understand which drugs are Forty-five percent of people who died were on
“After I took the drugs, I felt better and severe injury. However, concerns have Medicaid, translating to a 5.7-fold greater risk
for a while,” she says. “Then I got sick pipeline, normally reserved scientists study of overdose deaths in Washington State involved, as well as whether overdose deaths
been raised about the impact of an airbag on a are more common among poor people, the of prescription opiate overdose death among
again.” are quick to use words like “disaster” pregnant woman’s abdomen; there have been, due to prescription opiate drugs shows that
most of these deaths involved methadone, and researchers analyzed all prescription opioid Medicaid clients.
The headaches, chills and fever, or “catastrophe” when asked what for instance, case reports of uterine or placental overdose deaths in Washington between 2004 Studies have shown, noted the authors of the
might happen if they do not contain the rupture leading to pregnancy loss. that these overdoses were much more common
classic symptoms of malaria, wors- among people on Medicaid. and 2007. report, that people on Medicaid are twice as
ened. Chhien Rern’s daughter persuad- disease that is ravaging young Hong But until now, large-scale studies had been likely as those on private insurance to be pre-
lacking. Washington State has a particularly high rate Nearly 60 percent of the 1,668 people who
ed her to take a motorbike taxi past Da before it spreads to Africa. There, of poisonings with opiate drugs, according to died from prescription opiate overdoses were scribed opiates. And methadone, long used to
malaria already kills an estimated In the new study, researchers analyzed data treat heroin addiction, is increasingly being
washed out bridges and flooded cul- on 3,348 collisions involving pregnant women the report from state health officials and the men, the report indicates. Methadone was the
verts to the nearest hospital in Pailin, a 2,000 kids every day. Centers for Disease Control and Prevention cause of death in 64 percent of these cases, fol- prescribed as a cheap painkiller; prescriptions
in Washington State between 2002 and 2005. for this purpose rose more than 12-fold
dirty border town about 10 miles (16 For the past 50,000 years the malar- They found that for most pregnancy compli- (CDC) headed by its Commissioner Thomas lowed by oxycodone (23 percent) and
between 1997 and 2006.
kilometers) from O’treng. ia parasite has been evolving, and cations — including placental detachment from R. Frieden which is published in the CDC’s hydrocodone (14 percent).
“These findings highlight the prominence of
Doctors say there is a good chance migrating, alongside humans. It moves the uterine wall, fetal distress and Cesarean methadone in prescription opioid-related over-
that Chhien Rern was sold counterfeit within the huts of O’treng, and into delivery — there was no evidence of a higher dose deaths and indicate that the Medicaid pop-
drugs. neighboring towns when men like risk for women whose crash had involved an ulation is at high risk,” the researchers write.
People generate drug resistant Hong Da’s father and older siblings airbag deployment. “Efforts to minimize this risk should focus
malaria when they take too little medi- float from job to job. There was a higher rate of fetal death in on assessing the patterns of opioid prescribing
accidents involving an airbag — 1 percent, ver- to Medicaid enrollees and intervening with
cine, substandard medicine or — as is Some work is close enough for them sus 0.3 percent among women in accidents
to return home at night, but other jobs Medicaid enrollees who appear to be misusing
all too often the case around O’treng without an airbag deployment. these drugs,” they advise.
— counterfeit medicine with a pinch of keep them away for stretches of time. However, there were only two fetal deaths in They also suggest that other states look at
the real stuff. Once established, the They sleep in tight rows, sweating and each group, and the small numbers make it dif- trends in prescription opiate-related deaths,
drug-resistant malaria is spread by weary, in disintegrating bamboo huts ficult to draw conclusions, the researchers note “especially among Medicaid clients.” (RTRS)
mosquitoes. So one person’s counter- with workers who are also traveling, in the journal Obstetrics & Gynecology. ❑ ❑ ❑
feit medicine can eventually spawn and possibly infected with malaria. In the US, it’s estimated that nearly 33,000
widespread resistant disease. The concept of containing drug pregnant women are involved in car crashes Combat vets risk high BP: Can the stress
each year. These accidents are a leading cause of war cause high blood pressure? Military vet-
Yet in most parts of the world, peo- resistance has never been tried before. of fetal death. erans with repeated tours of combat duty are
ple routinely buy antimalarials over the Scientists wonder: How do you control Because airbags can help save lives, groups more likely to have high blood pressure than
counter at local pharmacies and treat the spread of a resistant parasite trans- such as the American College of Obstetricians non-combat veterans, US researchers have
themselves. mitted by mosquitoes that bite people and Gynecologists (ACOG) have long advised reported.
A recent study out of neighboring who live and work in infested jungle pregnant women not to deactivate their vehicle Their study of 36,000 servicemen and
Laos found 88 percent of stores selling areas, then scatter in all directions, all airbags. women, including 8,800 veterans of Iraq and
artemisinin-based drugs, the same ones the time? The current findings support those recom- Afghanistan, showed those with multiple com-
scientists are desperately trying to pre- This area, the former stronghold of mendations, said lead researcher Dr Melissa A. bat exposures were 33 percent more likely than
the murderous Khmer Rouge, has a Schiff, a professor of epidemiology at the other military personnel to say they had high
serve, were actually peddling fakes. University of Washington School of Public blood pressure.
Worse, nearly 15 percent of the coun- notorious history. Burmese migrant Health in Seattle. Service members who had personally wit-
terfeits were laced with small hints of workers who once mined rubies and She added, though, that the findings are nessed death due to war or disaster were 50
artemisinin, which could prompt sapphires in these now deforested hills “inconclusive” regarding both the risk of fetal percent more likely to have high blood pres-
resistance. The researchers found indi- are believed to have helped transport death and the risk of preterm labor. The sure, Nisara Granado of the Naval Health
cations that some were made in China, Continued on Page 32 researchers did find a higher rate of preterm A woman receives an H1N1 flu nasal spray vaccination during a clinic at the Bill Research Center in San Diego, California and
delivery among women whose accidents Graham Civic Auditorium in San Francisco, California. The city had 16,000 doses of the colleagues reported in the journal
involved an airbag — nearly 16 percent, versus vaccine on hand for residents of the city. (AFP) Hypertension. (RTRS)