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Professor Peter Winstanley: bringing malaria drugs to the global marketInterview with Professor Peter Winstanley 1/4/05 During medical school it seems we all have to do modules that are horrible acronyms. At Liverpool they call them SSMs (special study modules). During one of these SSMs I was introduced to Professor Peter Winstanley. He taught a small group of us about pharmacology using malaria as a paradigm disease. He taught us that there is much more to dealing with tropical diseases then giving out small pills. Issues concerning culture, society and poverty are every bit as important as matters like bioavailability, active ingredients and metabolic products. Each has its place and must be considered if all the other pieces are to fall into place. He was also extremely friendly, an involved and interested doctor and a man who hated bureaucracy and didn’t mind being blunt about it. So I decided to take an afternoon off from worrying about my own research project at Leeds, where I am intercalating, and go back to Liverpool to speak with him about some of the things that I thought he might have opinions about. Professor Winstanley works for the University of Liverpool[1] and directs the Wellcome Trust Tropical Centre[2]. The Wellcome Trust is a charitable organisation set up by Henry Wellcome in 1936, who was a philanthropist with a particular interest in bio-medical research in the tropics. As a trust fund it has always been independent of Wellcome PLC, the pharmaceutical company[3,4]. Furthermore in the early 90’s the Wellcome Trust sold a large proportion of its shares in Wellcome PLC and spread them across the stock market. This means that the Wellcome Trust has considerable financial resources. The Trust is managed by scientists of international repute. The Prof started his interest in malariology by working towards academic positions, reading for a Doctorate in ‘The clinical pharmacology of amodiaquine’ and eventually securing a position as a Professor of Pharmacology at Liverpool. He feels that this has helped his vision of International Health, as he has been able to apply the ‘rigour of the bench’ to all his work. Working from ‘the micro to the macro’ has provided him with clarity about international health developments, but he appreciates the role that other disciplines have in providing health care in developing countries. I asked him about conflicts of interest. Personally he has never had a conflict between his various funders, but does acknowledge that every researcher cannot be entirely altruistic. He admits to obvious academic interests in what he is doing, needing to achieve academic goals whilst providing affordable drugs to those in need. He maintains that as long as you ‘know yourself’ it is better to be aware of your motivations because it allows you to critically analyse your own work. He has had conflicts - in a more general sense - however, due to the politics involved in the contentious area of providing drugs to those suffering from malaria. For example, the new antifolate antimalarial drug Lapdap™ (chlorproguanil-dapsone) developed by Professor Winstanley and Dr Bill Watkins at Liverpool University in close partnership with others, has now started phase 4 trials[5,6,7]. Winstanley is frustrated by the political ‘wrangling’ that has surrounded the launch of this drug and wants good evidence to support policies, not bureaucracy. This is especially irritating as the ‘big Pharma’ backers of Lapdap™ have agreed to provide the drug on a ‘not for profit’ basis to the 20 African countries who have registered it[8]. We spoke about the recent developments in the drug patent laws that are taking place in India[9]. He did think that ‘poor people should have access to good drugs, profit isn’t an issue.’ The issue that Professor Winstanley was particularly interested in, however, was not one of cost but quality. He felt that ‘big Pharma’ spent huge sums of money monitoring not just the active ingredients but the contaminants and the stability of the breakdown products. This helps the pharmaceutical companies decide on the safe shelf life of the products. If smaller generic manufacturers did not apply the same thorough testing to all their products, then people could be exposed to dangerous contaminants (Winstanley stressed that the majority of generic manufacturers do adhere to high quality standards). Another point that was raised is that pharmaceutical companies form part of our global economy and that, without their dependability for profit making, the economy would suffer. The current system was in the Prof’s eyes probably as good as possible. Although pharmaceutical companies are bound to be mainly interested in making profits and protecting their share prices, they have considerable motivations for being ‘good corporate citizens’. These motivations include enhancing their corporate image. His suggestions for improving the system were that more institutions like the Medicines for Malaria Venture [10] could help, and also the concept of ‘risk sharing’ by companies, through public/private partnerships, to reduce the vast cost of bringing drugs to the market. In speaking again to Professor Winstanley after a period of studying International Health, I was in a position to engage him on a great many more subjects but, once again, he has provided me with a fresh perspective and much food for thought. Tom Poyser References Alma Mata is a not-for-profit organisation for those interested in further education, research and careers in global health.
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