The Opposite of Martin Shkreli: Drug Development Without Profit

From inside the van, Nathalie Strub Wourgaft watches the scene unfold in silence. She looks tired, and a little tense. Wourgaft is the medical director of a Geneva-based organization devoted to developing treatments for syndromes that afflict the poor, called the Drugs for Neglected Diseases initiative (DNDi), and she is in Sudan for just 3 days to scope out the setting for a clinical trial that will be the first of its kind.

By May, Wourgaft and a Sudanese surgeon, Ahmed Fahal, hope to test a new drug for a potentially lethal, flesh-eating fungal infection called mycetoma. It begins with a cut—a prick of an acacia thorn, perhaps—that is infected by a fungal spore. Even though mycetoma is fairly common in some parts of Sudan, it will not be trivial to find study participants because they must have recent infections, which would be more likely to respond to the new drug, Fosravuconazole.

Most of the time, Fahal only sees patients once their limbs are swollen, lumpy, and filled with fungus that protects itself from drugs and the immune system with hardened encasements. So Wourgaft and Fahal have come to this desolate belly of Sudan to see if they can find people with recent infections that might be cured with anti-fungal medicine. But in November, villagers are tending plots of corn, beans, and other crops irrigated by the Nile River. Although Fahal sent word of his visit in advance, he’s worried the turnout will be low...