Reader Comments

Post a new comment on this article


Posted by plosmedicine on 31 Mar 2009 at 00:16 GMT

Author: Jose Luis Portero
Position: MD, PhD
Institution: Proyecto Centro de Referencia para el Control de Endemias. Fundación para la Cooperación y la Salud Internacional Carlos III. Malabo. Equatorial Guinea
Additional Authors: Maria Rubio
Submitted Date: November 08, 2007
Published Date: November 9, 2007
This comment was originally posted as a “Reader Response” on the publication date indicated above. All Reader Responses are now available as comments.

Casenghi et al[1] call attention to the current funding paradigms and strategic approaches shortcomings regarding tuberculosis drug discovery. It is time to rethink after the initial euphoria arising from the identification of an unexpected number of new patented compounds with antimycobacterial activity in the last years[2] and the key role played by the Global Alliance for TB Drug Development (GATB) to foster lead agents into development. Despite all this, a Monte Carlo simulation model has estimated that the probability of developing a new anti-TB agent by 2010 remains less than 5%[3].

Early stages of TB drug development need basic research that is mainly funded by the public sector, while the private sector has the expertise and technology to develop new drug candidates taking advantages from it. It seems rational that public-private collaboration would be the right answer. However, public and private do not share the same responsibilities on public health and tuberculosis control. Public sector has to provide the grounds and to be responsible of the entire process of tuberculosis drug discovery since the market will be always deficient[4]. Restrictions due to market laws, patent system and intellectual property rights, only can be overcome from the governments.

Essential medical research and development, as it is tuberculosis drug development, is a public good that should be sheltered from market forces. Moreover, as Michel Callon said “science is a public good, not because its intrinsic properties but because it is a source of diversity and flexibility”[5].

Global TB crisis has been mainly fuelled by the weakness of the public health systems that were unable to control it, regardless of the worldwide availability of rifampicin-containing regimens with high antimycobacterial efficacy. We have to learn the lessons. In spite of the GATB and other stakeholders being welcomed, only the commitment and financial support of governments can properly accelerate and sustain TB drug development and, in a final term, tuberculosis control[2].


1. Casenghi M, Cole ST, Nathan CF (2007) New approaches to filling the gap in tuberculosis drug discovery. PLoS Med 4(11): e293. doi:10.1371/journal. pmed.0040293

2. Portero JL, Rubio M (2007) New anti-tuberculosis therapies. Expert Opin. Ther. Patents 17(6):617-637

3. Glickman SW, Rasiel EB, Hamilton CD, Kubataev A, Schulman KA (2006) A portfolio model of drug development for tuberculosis. Science 311:1246 -1247.

4. Trouiller P, Olliaro P, Torreele E, OrbinskiI J, Laing R, Ford F (2002) Drug development for neglected diseases: a deficient market and a public-health policy failure. Lancet 359:2188 -2194.

5. Callon M (1994) Is science a public good?. Science, Technology, and Human Values 19: 395-424.

Competing interests declared: We don´t have any competing interests to declare