Case Study 4

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MERCK IN AFRICA (abridged) *

We try to remember that medicine is for the patient. We try never to

forget that medicine is for the people. It is not for the profits. The profits

will follow and if we have remembered that, they have never failed to

appear. The better we have remembered it, the larger they have been.

How can we bring the best of medicines to each and every person? We

cannot rest until the way has been found to bring our finest

achievements to everyone.

George W. Merck

1950 Address at the Medical College of West Virginia (Richmond)

Pharmaceutical companies typically invest heavily in research with uncertain potential. These

companies spend inordinate time and resources developing drugs that might not have clear uses for 10

to 20 years, if at all. In fact, it is often the case that drugs are found to have uses other than those

intended.

Merck is no exception. Like other pharmaceutical companies, Merck has a history of engaging in

general research with vague hopes in mind. During the late 1970s, for example, Merck spent

considerable time collecting soil samples in search of naturally occurring antibiotics, without a clear view

of what ailments might be treatable by those antibiotics. In the process, Merck stumbled upon a

compound in one of 54 soil samples collected from the Kitasasto Institute of Japan. This compound,

ivermectin, seemed effective in treating diseases in animals caused by parasites. After further research,

it was found that ivermectin was particularly useful in treating horses to kill a gastrointestinal parasite,

Onchocerca cervicalis.

Researchers at Merck immediately notice the similarity between Onchocerca cervicalis and

Onchocerca volvulus, the cause of Onchocerciasis. Onchocerciasis is commonly known as “river

blindness.” River blindness is spread by parasitic worms carried by small black flies. Infected humans

suffer from terrible itching, depigmentation of the skin and often blindness. This disease has proved

crippling for many people in some of the poorest areas of the world. Most of the victims of river

* This case is based on a real situation. Some of the names and events have been disguised or modified for the

purpose of illustration for the intended class discussion. Copyright © 2012 by Neu Academic Press. To order copies or request permission to reproduce materials please go to http://www.study.net. No part of this publication may be reproduced, stored in a retrieval system, used in a spreadsheet or transmitted in any form or by any means—electronic, mechanical, photocopying, recording or otherwise—without the permission of Neu Academic Press.

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blindness are in Africa, though people in the Middle East and Latin America are also affected. As of 1978,

85 million people suffer from river blindness, and an additional 120 people remain at risk.

Researchers at Merck believe that ivermectin could hold the answer to river blindness, with

limited additional research; they would simply need to develop a form of ivermectin suitable for human

consumption. Were this any other situation, Merck would not hesitate—the investment of millions of

dollars would constitute barely a drop in the bucket as compared with the potential income that could

be generated from a successful drug. But the people suffering from this infliction are not able to pay

even a small portion of the cost of the drugs. It would be likely that Merck would not even be able to

recoup its initial investment were Merck to take the steps necessary to develop the cure for river

blindness.

You are hired by Merck as consultant. How do you advise Merck to move forward?