A Mid­dle East health-care revo­lu­tion

Financial Mirror (Cyprus) - - FRONT PAGE -

On a re­cent visit to Jor­dan and Egypt, as part of a trade mis­sion led by the United States Depart­ment of Commerce, I was struck by the po­ten­tial for the sur­round­ing re­gion to be­come a ma­jor hub for cut­tingedge medicine. With the right pol­icy mix and enough po­lit­i­cal will, the Mid­dle East could be­come an im­por­tant part of the world for health-care re­search. In par­tic­u­lar, it has a crit­i­cal role to play re­gard­ing phar­ma­ceu­ti­cal clin­i­cal tri­als de­signed to in­ves­ti­gate the in­flu­ence of pa­tients’ re­gion of an­ces­try on the safety, ef­fi­cacy, and ef­fec­tive­ness of treat­ments.

As our un­der­stand­ing of ge­net­ics ex­pands, it is be­com­ing clear that our an­ces­tral ori­gins play a key role in de­ter­min­ing the ef­fi­cacy of cer­tain medicines. For ex­am­ple, stud­ies have shown that pa­tients of Euro­pean an­ces­try re­spond bet­ter to beta block­ers and ACE in­hibitors than those of African de­scent. And con­ti­nen­tal ori­gins are of­ten con­sid­ered when se­lect­ing op­ti­mal an­ti­hy­per­ten­sive and car­dio­vas­cu­lar drug ther­apy.

An­other ex­am­ple is war­farin, an an­ti­co­ag­u­lant. Re­search has found that pa­tients of African de­scent re­quire higher doses than those of Euro­pean ori­gins; pa­tients with Asian an­ces­try re­quire lower doses. Stud­ies of tacrolimus, a drug used to pre­vent or­gan re­jec­tion in trans­plant pa­tients, in­di­cate that African-Amer­i­can pa­tients re­quire higher doses than their white peers.

Ge­netic re­search has also ex­panded our un­der­stand­ing of diseases. For ex­am­ple, re­search by the US Agency for In­ter­na­tional De­vel­op­ment (USAID) found that epi­der­mol­y­sis bul­losa, a de­bil­i­tat­ing in­her­ited skin dis­or­der, has a dif­fer­ent ge­netic sig­na­ture in pa­tients from the Mid­dle East than in those from other parts of the world.

As our un­der­stand­ing of diseases grows, more re­search is needed to de­ter­mine the ef­fec­tive­ness of so­phis­ti­cated new medicines in spe­cific pa­tient pop­u­la­tions around the world. Such in­ves­ti­ga­tions are al­ready un­der­way in some re­gions. In Asia, the Hu­man Genome Or­gan­i­sa­tion es­tab­lished the Pan-Asian Pop­u­la­tion Ge­nomics Ini­tia­tive to study ge­netic di­ver­sity and eval­u­ate vari­a­tions in drug re­sponse in the re­gion. In Mex­ico, the In­sti­tute for Ge­nomic Medicine is geno­typ­ing the coun­try’s en­tire pop­u­la­tion.

Es­tab­lish­ing a sim­i­lar ef­fort in the Mid­dle East will re­quire col­lab­o­ra­tion among phar­ma­ceu­ti­cal com­pa­nies, aca­demic in­sti­tu­tions, non-profit or­gan­i­sa­tions, gov­ern­ments, and health-care providers. Or­gan­i­sa­tions like USAID and the US Naval Med­i­cal Re­search Cen­ter, which are al­ready con­duct­ing clin­i­cal re­search in the re­gion, could be­come valu­able part­ners in co­or­di­nat­ing and man­ag­ing tri­als.

The first step that the Mid­dle East can take is to align reg­u­la­tions across the re­gion, with coun­tries agree­ing on the pa­ram­e­ters for test­ing drugs’ safety and ef­fi­cacy in the lo­cal pop­u­la­tion. Clin­i­cal ac­tiv­ity is in­creas­ing across the Mid­dle East, and the health-care ecosys­tem needed to sup­port re­search is grow­ing in size and so­phis­ti­ca­tion. And yet, when it comes to new treat­ments, reg­u­la­tory bod­ies in the re­gion gen­er­ally fol­low de­ci­sions made by the US Food and Drug Ad­min­is­tra­tion (FDA) and the Euro­pean Medicines Agency (EMA), with­out ex­ten­sively study­ing a drug’s safety and ef­fi­cacy on lo­cal pa­tients.

Ap­provals must take place on a na­tional level, but re­gional lead­er­ship will be nec­es­sary. Jor­dan, for ex­am­ple, has a so­phis­ti­cated health-care sys­tem and a thriv­ing med­i­cal tourism sec­tor. It is also the site of an in­creas­ing num­ber of clin­i­cal tri­als. As such, it is well placed to set the stan­dard for re­search re­quired to show a drug’s safety and ef­fi­cacy in pa­tients of Mid­dle East­ern an­ces­try.

It is im­por­tant to move quickly. The in­ci­dence of chronic diseases is in­creas­ing rapidly across the Mid­dle East. Ac­cord­ing to the In­ter­na­tional Diabetes Fed­er­a­tion, rates of diabetes in the Mid­dle East and North Africa will rise 96.2% by 2035, with the United Arab Emi­rates, Oman, and Qatar pre­dicted to have the high­est growth rates. Like­wise, the World Health Or­gan­i­sa­tion es­ti­mates that more than a quar­ter of adults in Egypt have hy­per­ten­sion, while car­dio­vas­cu­lar diseases ac­count for 35% of all deaths in Jor­dan. De­vel­op­ing new, more ef­fec­tive treat­ments will be cru­cial to ad­dress­ing th­ese chal­lenges be­fore health­care costs spi­ral out of con­trol.

The Mid­dle East is best known for its an­cient his­tor­i­cal sites, po­lit­i­cal in­sta­bil­ity, and abun­dant nat­u­ral re­sources. But, by de­vel­op­ing its abil­ity to make med­i­cal ad­vances, the re­gion could be­come a world leader in deep­en­ing our un­der­stand­ing of the role of ge­net­ics in the safety and ef­fi­cacy of med­i­cal treat­ments.

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