RESUMO
From 1936 until 1996, the drug dapsone treated a diverse array of diseases, including tuberculosis, leprosy, malaria, and AIDS-related pneumonia. This article explores how dapsone transformed from a cure for one disease into a treatment for a totally different malady. This process of reinvention in the clinic represents an alternative model of drug development that the historical literature, focused on success in the laboratory, has largely ignored. The core of the paper discusses the reinvention of dapsone as an antimalarial in the Vietnam War through trials led by Robert J. T. Joy, a physician and military officer. As a case study, it offers a fresh perspective on the clinic-as-laboratory approach that other scholars have addressed in a civilian context. Viewing the randomized clinical trial (RCT) through a military prism will demonstrate how a combat environment combined with the regimentation of the armed forces affected the standard methodology of the RCT.
Assuntos
Antimaláricos/história , Dapsona/história , Dapsona/análogos & derivados , Indústria Farmacêutica/história , História do Século XX , Humanos , Hansenostáticos/história , Hanseníase/história , Malária/epidemiologia , Medicina Militar/história , Militares/estatística & dados numéricos , Pneumonia por Pneumocystis/história , Ensaios Clínicos Controlados Aleatórios como Assunto/história , Guerra do Vietnã , p-Aminoazobenzeno/análogos & derivados , p-Aminoazobenzeno/históriaRESUMO
From 1936 until 1996, the drug dapsone treated a diverse array of diseases, including tuberculosis, leprosy, malaria, and AIDS-related pneumonia. This article explores how dapsone transformed from a cure for one disease into a treatment for a totally different malady. This process of reinvention in the clinic represents an alternative model of drug development that the historical literature, focused on success in the laboratory, has largely ignored. The core of the paper discusses the reinvention of dapsone as an antimalarial in the Vietnam War through trials led by Robert J. T. Joy, a physician and military officer. As a case study, it offers a fresh perspective on the clinic-as-laboratory approach that other scholars have addressed in a civilian context. Viewing the randomized clinical trial (RCT) through a military prism will demonstrate how a combat environment combined with the regimentation of the armed forces affected the standard methodology of the RCT.
Assuntos
Antimaláricos/história , Dapsona/história , Malária/história , Ensaios Clínicos Controlados Aleatórios como Assunto/história , Antimaláricos/uso terapêutico , Antituberculosos/história , Antituberculosos/uso terapêutico , Dapsona/análogos & derivados , Dapsona/uso terapêutico , História do Século XX , Humanos , Hansenostáticos/história , Hansenostáticos/uso terapêutico , Hanseníase/tratamento farmacológico , Hanseníase/história , Malária/tratamento farmacológico , Pneumonia por Pneumocystis/tratamento farmacológico , Pneumonia por Pneumocystis/história , Tuberculose/tratamento farmacológico , Tuberculose/história , Guerra do VietnãAssuntos
Sulfonas/história , Áustria , Dapsona/história , Dapsona/uso terapêutico , História do Século XIX , História do Século XX , Humanos , Hanseníase/tratamento farmacológico , Hanseníase/história , Malária/tratamento farmacológico , Malária/história , Dermatopatias/tratamento farmacológico , Dermatopatias/história , Sulfonas/uso terapêuticoRESUMO
A historic introduction reviews the start of DDS (diaminodiphenylsulphone) therapy in leprosy, stressing the fact that, far after the start of combined therapy in tuberculosis, leprosy continued to be treated with monotherapy of DDS. Reports about resistance of M. leprae to DDS initiated a review of policy. A complete breakthrough toward combined therapy started after 1962, when Shepard introduced mousefootpad inoculation of M. leprae to be used for therapeutic trials. Full attention is given to Freerksen's trial in Malta where combined treatment with rifampicin, INH, prothionamide, and DDS were given for 2 years only to all patients, while at resurvey after 4 years no relapse was found. The applicability of short-term combined therapy for endemic areas is discussed.