First malaria treatment for babies approved for use | Hacker News Reader

First malaria treatment for babies approved for use

bbc.com

137 pointstoomuchtodo43 comments

I heard this story on the radio last week, and the Italian physician working in Africa for a very long time said that the treatments have been provided for babies older than 6 months successfully. The new and important step (with Novartis) is to now safely treat babies younger than 6 months with the appropriate dosing. I wish I could find the link to the radio story.

Unless I'm reading the original study [1] wrong, I'm surprised the study only used a population size of 28.

They did do a 12 month check-in which is good, but why such a small group of study participants, especially when malaria is so widespread?

[1] https://clinicaltrials.gov/study/NCT04300309?term=CALINA&ran...

Also they apparently didn't use a control group, the study was terminated early, and after the 43 day test window 9 of the 28 participants are listed as having the adverse event of malaria.

I'm particularly confused by that last one. How is malaria considered an adverse event when testing an anti-malaria treatment? Other data in the study shows that 1 participant had malaria again with matching DNA, meaning the original infection likely came back. 6 others were reported as getting malaria again but with different DNA. So what does it mean to have 9 with the adverse event of malaria?

Think you're over-parsing a bit: adverse events ~= something we should mention, not Bad Things The Treatment Did. "What does it mean?" is a qualitative question, not a quantitative one. Taking that question more colloquially, in this case, I'd say it means "the vaccine did not prevent infections in 9 of 28 cases and / or they had an infection before the vaccine was taken"

I'm sure you mean well -- since your post, the thread got cluttered up with outright know-nothing-type comments. I am being very literal in order to help teach people in despair what we expect when we read these.

I did mean well, thanks for assuming good intent here. I still don't understand how 9 of 28 could have the adverse event of malaria, though, given that other data in the results show that 1 participant had what seemed to be a reinfection with a genetic match and 6 others were infected again with a parasite that didn't match their original infection's genetic makeup. That is 7 individuals, where do the other 2 come from?

My uncertainty is that I may be misunderstanding the meaning of malaria as an adverse event entirely here - I don't get how reinfection would be an adverse event rather than a potential failure of treatment.

Statistical power. Malaria doesn’t go away on its own. They know the treatment should be overwhelmingly effective if dosed correctly, it’s merely a measure of determining dosage vs negative effects.

The famous comparison: you do not need a large N to test the effectiveness of parachutes.

Right, in this case my concern really wouldn't be with efficacy as much as safety. When the test group is only 28 participants how can we assume that we would have found most of the safety concerns? Is the assumption being made that the only concerning factor is age and that there are no other contribution factors that could lead to negative outcomes?

Ethics dictate always using the smallest viable cohort to show that giving the treatment regimen (in this case dosage for a drug known to be effective) isn't obviously worse than the thing it's supposed to treat, even if we're already pretty sure. This also keeps the costs of running the studies down so we can effectively conduct more studies for more treatments.

We also already have data about its use in babies over 11 lbs, and this is just going even smaller to 4.4 lbs, so a strong baseline has already been demonstrated.

a small study.... that then gets approved and released to everyone!

A little dull assertion can't hurt you, individually, and I bet it feels fun.

I assume you're well-aware the process for something like this doesn't fit in a sentence.

Additionally, there's context in the comment you're replying to, this isn't the only study.

What do you mean "ethics dictates?" We define ethics and they generally reflect the current culture, ethics aren't universal and can't dictate anything.

The scientific method, though, would dictate that a cohort size should be large enough to show a high probability of safety and efficacy, assuming that is what is being tested. It would also dictate that a control group would be needed to compare against the test group.

I totally understand the ethical concerns of potentially allowing children to be harmed while part of a control group, but when the test is being done specifically because there is currently no treatment the only change is that they would pick a group of untreated children that are a valid control group for the study. Either way those children wouldn't be treated and there really isn't an ethical issue to deal with.

There is a treatment, but it's done ad-hoc:

> Until now there have been no approved malaria drugs specifically for babies.

> Instead they have been treated with versions formulated for older children which presents a risk of overdose.

The claim still holds then that there are no approved treatments for malaria in this age range. If we were already treating patients off book, and that were the reason we couldn't have a control group, then there is no real reason to do the study at all.

Having a control group in a life saving intervention study is a major ethical dilemma that isn't as simple as they would die if not in the study.. There's a lot of information about study ethics and it is more complex a subject than you imply.

Is it in this case though? The study, and the related article, states that there is currently no approved treatment for the population. What is the harm in following a control group that would otherwise still go untreated?

It is pretty common to have a very small (and usually not exactly random) sample size.

Whether its common doesn't really matter. Are you arguing that a small, non-random sample size is acceptable in a scientific study?

I think if we take off our pedant caps we can easily understand that the nature of scientific research on living people is rife with unique restrictions and circumstances. And, more mundanely, that when a medication is proven through widespread use over decades in one population, the standards to study the impact on other, very similar populations does not always require the most onerous approach.

I'm not sure how this would fall under a pedantry label. If we are okay assuming that a medication used widely for other age groups is safe for infants, why bother with an incomplete study that was never designed to produce statistically significant results?

The study is only useful if it can show safety and efficacy of the dosage levels for the test population. I'm not trying to argue that the study was even necessary if the safety and efficacy can be implied, only that if the study is to be done it should at least be setup with a chance of proving the needed results.

https://www.reuters.com/business/healthcare-pharmaceuticals/... | https://archive.today/Gsw4p

Good news! How do you safely develop medications for babies?

This particular one is mostly about dosing, the available medicines were weight based, with lowest dosages in the 5-15kg range. This brings dosages lower allowing more precise dosing for the lighter babies.

Edit: it's a very welcome addition. Limits side effects.

I wonder how RFK Jr will look at this...

China had been, until recently, for decades, the most populated country in the world. Still Chinese people don't have a problem called malaria. Why ?

Because they use a plant to prevent and heal it. I can't recall the name of this plant but I remember I saw a documentary stating that China tried multiple times to export that plant to the world but Bill Gates, who is interested in the subject and wanted to develop a vaccine for malaria, for a long time convinced the world health organization to not allow that on the name that the plant has health risks, inefficient and is dangerous to the environment.

The Chinese medicinal herb you're thinking about is sweet wormwood, from which we isolated artemisinin. Artemisinin isn't a suppressed secret. It's one of the major treatments for malaria and it netted its discoverer a Nobel prize.

The drug the article is talking about contains artemisinin in combination with another substance.

We know how to deal with malaria, so this isn't some story of Big Pharma hiding the truth. The disease used to be endemic in the US and in Europe. Better treatments save lives, but eradication hinges on economic and political factors... which are in turn not helped by malaria.

> "We know how to deal with malaria, so this isn't some story of Big Pharma hiding the truth. The disease used to be endemic in the US and in Europe"

Malaria is still a public health concern in Africa. And that's where Bill Gates does not want to see that plant exported to Africa because, unlike the Big Pharma products, it is a cheap solution.

I do not think we are talking about the same plant because "sweet wormwood" exists in Africa (a variant of it). Unfortunately I can't find the documentary I saw some years ago about this. It was done by few French investigation journalists.

Having lived in several African countries and studied Sino-African relations I can say with certainty, that both Chinese and Africans couldn’t give less of a shit about what Bill Gates wants if there is a product that Chinese people want to sell and Africans want to buy.

No, that's not how trade functions. You can't sell what you want, where you want.

Trade is subject to lobbyism (to say the least)

Sure, but the US or US-based businessmen are hardly the only actors lobbying and if you look at the trade balances of basically all African countries, Chinese interests are far more successful in exploiting African markets than US concerns. Add to this that several African countries have basically no diplomatic relationship and/or are openly hostile to the US and it makes no sense at all that they would forego a cheap and self-sufficient remedy to malaria (if it existed), just to please big Pharma.

TFA is literally about a wormwood related drug being used to treat babies in africa.

It's a traditional medicine for malaria, and the reason china wasn't exporting it was due to the military importance of anti-malaria medicine. This was a thing before Bill Gates was rich or powerful. Since then, I'm not really aware of any suppression of the drug. The only anti-malaria treatment which has been suppressed by US interests is the vaccine, because they didn't believe it was profitable. Now that it is profitable, they're going forward with it.

Now that the white wormwood based treatment is known worldwide, there are questions about whether it should be kept in reserve like quinine. I'm not sure if things have changed, but I recall an approach is to give Artemisinin alongside another treatment, to prevent malaria from adapting. In africa, people will commonly listen to the doctor's instruction to take the whole course of medicine and will ignore it and just take half. They give the other half to a relative. This causes treatment resistant malaria to develop.

Approved for use means approved for testing on populations.

Isn't that how medicine works?

Only for lab mice. Humans require making it clear that they are not being used as lab mice. But often, you see report saying that "After seeing the results for x years of use by populations, we found that it has y side effect which was not known earlier". A doctor literally said this to me last week.

What alternative process do you propose that will discover all side effects, including those with well under 1% occurence, without human use?

> "After seeing the results for x years of use by populations, we found that it has y side effect which was not known earlier"

I would think that any reasonably intelligent adult could think about things for a few moments and come to the realization that... yeah, that's how things work. This is how we progress and learn. We develop, test, use, and learn about things - and if we learn that hey, turns out, this is bad over a long period of time... we change things.

And this of course doesn't apply to just medicine - it's just technological progress.

What's the alternative? "Oh, sorry, we would like to treat your baby's malaria, but that would disregard the baby's inherent dignity: we don't yet know the full side-effect profile up to 3 sigmas."

Most indignities are lesser than dying of malaria.

No one in the US is going to force you to take medication. You are free to die. You are also free to leave.

Some humans might be perfectly willing to be used as lab mice. Those predestined to die soon or have very low quality of life for instance. That's why some advanced cancer patients can get very experimental meds.

It gets pretty bad though when others are affected, cf. Thalidomide babies.

As opposed to what?

Probably as opposed to “approved for general use in the population because we’ve passed all of our tests”, which is what I’d assume “approved for use” means

Are you taking the stance that no drug should ever be released on the basis that it is impossible for trials to cover literally the entire population? Like, what are you looking for here?

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