TRANSCRIPT 🔗
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The Himalayan lion stands on a ridge he has known
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since cubhood. Below, a road cuts through the
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valley. Off -road vehicles climb where no wheels
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have ever turned. They carry emblems of lions.
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French, Australian, Chinese, German. Stamped
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on grills that cuff back diesel into air that
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once smelled of juniper and snow. His kingdom
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Once inaccessible, is shrinking. The herbs thin.
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The prey scatters. The silence breaks daily.
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The biochemist arrives on foot. He carries a
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canvas bag and a troubled face. Twenty years
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ago, he climbed this mountain once a year and
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left smiling. Now he comes monthly. And every
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visit brings complaint. The fish are suffering,
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the line says. The ocean creatures, too. The
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forests are thinner each season. The biochemist
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nods. Natural products have contributed to roughly
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a third of approved small molecule drugs over
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four decades. Yet biodiversity loss threatens
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the source of that innovation. The raw material
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disappears before it can be studied. I need funding,
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he says. My lab is barely surviving. My sequencer
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sits under a dust sheet. The grant that paid
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for it ended two years ago. I cannot afford the
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data the regulators now demand. Chemistry, manufacturing,
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controls. The systems are built for companies
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with armies of lawyers. The lion tilts his head.
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You speak of systems? What of the old knowledge?
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The forest was our pharmacy. It still is. But
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the pipeline does not see it that way. Hello
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and welcome to brand new series on Population
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Health Weekly with Shah Noor Azhar and Aaron
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Rodgers. This series is titled The Molecular
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Pipeline, bringing to you all that you need to
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know about the arrival of medicines, vaccines
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and therapies at your bedside and if we get them
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in time. But before going any further, welcoming
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Aaron Rodgers to the start of our fifth series.
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Time is flying, Aaron.
Load full transcript
Indeed, it's flying, Shanoor.
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And good to have the pool of our regular listeners
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growing. Hello to all of you. In our first series
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in June, The Rise and Rise of Elderly, we briefly
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touched upon biopharmaceuticals in the episode
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titled, The Biopharma Balancing Act. This episode
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is available on ideas .org .es. But we will take
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a deep dive on this topic today, in our first
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episode of the Molecular Pipeline. Later in the
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show, we hear the dispatch by Dr. Bilal Zafar,
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a practicing physician and friend of the show.
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This is a segment in which we send him a question
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and he answers through a recorded audio. So stay
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tuned to hear from an expert on how to differentiate
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between ordinary tiredness and occupational fatigue.
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Shenor, the dialogue between a Himalayan lion
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and the biochemist is quite rare, and what you
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narrated earlier is extraordinary, especially
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that this conversation is happening within the
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lion's own territory. I'm super curious now.
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You'd be listening to a rare dialogue, Erin.
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That's for sure. The biochemist explains what
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he has learned. At the earliest stage, the search
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for a target? The science is brutal. A target
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is a lock in the body, usually a protein. Some
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locks are enzymes. Some are receptors. Some are
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genes. The key must match the lock, or the body
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pays the price. Plants and fungi evolved their
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chemistry to survive. That chemistry sometimes
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fits human locks better than anything designed
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from scratch. But the lock must be chosen first.
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And choosing is excluding. The targets that get
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studied are the ones someone can afford to study.
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Rare diseases in poor countries wait longest.
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I have sent 90 molecules towards the clinic,
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the biochemist says. Nine reached it. Preclinical
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means before humans. Cells, animals, simulations.
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Most molecules die there. The industry calls
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it the valley of death. The lion listens. And
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the ones you make in the lab? Synthetic biochemicals,
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gene therapies, monoclonal antibodies. The failure
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rates remain high. Phase 2 is the graveyard.
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The model was wrong. The animal did not predict
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the human. The lion looks towards the road. And
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the smaller labs? The pipeline rewards scale.
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If you cannot afford the failure, you cannot
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afford the cure. Even when we find something.
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The patents close behind us. Patent analysts
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report that biologic drugs average more than
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20 patents each. Some carry walls of over 100.
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Small labs cannot litigate their way through
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that. And the biosimilars? The copies that should
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widen access face hurdles the originators never
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did. Biologics are biology. Cells, proteins,
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antibodies. Small molecules are chemistry. The
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pipeline treats them differently and the rules
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are harder for the second kind. And the regulators?
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The biochemist pulls a four -lit page from his
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bag and clears his throat. They move at different
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speeds. Regulators report that the Food and Drug
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Administration or FDA's median review is about
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300 days. The European Medicines Agency or EMAs
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is over 400. China's approval lag for drugs already
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cleared by the FDA in the United States fell
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from nearly 1700 days to 600. But it still lags
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behind Japan and Europe. A drug approved in one
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country may take years to reach another. So the
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pipeline is not one pipeline, the biochemist
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explains. It is many. With different gates. Different
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guards. Different speeds. The line nods slowly.
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And we're not the ones who choose which gate
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opens." The lion hears the vehicles. He remembers
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a plant the old healers used for pain. One he
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once saw made into rope and cloth, carried across
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valleys, even rigged to sails on ships. He hasn't
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seen it in that abundance for decades and wonders
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quietly why. The biochemist once told him that
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natural
products have been the inspiration for
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over half of approved anti -cancer. anti -infective,
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and anti -diabetic drugs. But the forest is thinning,
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and the ocean is emptying. The biochemist's bag
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holds fewer specimens each year. The population
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grows, the lion says. The diseases change, the
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burden increases, and your discoveries slow.
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That is the paradox. We need nature more than
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ever, but we are destroying it faster than we
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can study it. The lion sniffs the diesel -laced
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air. Your species chose speed. Now the diseases
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travel faster than the cures. The biochemist
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does not argue. He thinks of a child in his village,
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a fever that a local root once treated, now waiting
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for a foreign drug that may never arrive. The
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plant is gone. The knowledge is fading. Dependence
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is a kind of erasure. The Himalayan lion rises.
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Then we agree. Prevention, not just treatment.
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If the planet sickens, the target is not only
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the molecule, it is the world that makes us sick.
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You in your lab, me in my kingdom. The biochemist
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looks at his bag. Planetary prevention. The molecule
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is only the beginning. Then the testing. The
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cells. The animals. The stand -ins. The lion
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growls softly. The target, he understands now.
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The target is never just a molecule. It's a decision.
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What to study? What to protect? What to leave
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behind? The forest was the first pharmacy. Do
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not let it become the last memory. The biochemist
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pulls a leaf from his bag. Small, green, still
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fragrant. You do not need a lab to protect the
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locks in your body, the lion says. Walk where
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the air is clean. Eat what grows nearby. Sleep
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when the dark comes. And maintain all of it as
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much as possible. The biochemist smiles. Small.
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Repeated. Local. Yes. Next week, we see guinea
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pigs approaching the pipeline. Shenor, please
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let me know if I can help either the lion or
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the biochemist. Sure, Aaron. I hope our listeners
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will be interested in helping them too because
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they both need it. And now it's time to hear
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the dispatch by Dr. Bilal Zafar. This is a segment
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in which he answers our question coming from
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last month's series. And because we toured the
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cognitive factory throughout last month, we asked
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the doctor. How does a clinician tell the difference
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between ordinary tiredness and something that
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needs clinical attention? What signs should a
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worker take seriously? Let's play the recording.
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I'm traveling right now. So Shanur, I think you
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may have raised a very valid point when you spoke
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about fatigue. Now, I think it's important to
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know when fatigue matters and when it doesn't
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matter. So we're just going to speak about some
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of the different population groups that can be
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at risk with this. So first of all, we're going
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to talk about our friends on the road. Now, this
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includes long distance truckers or everyday delivery
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drivers, couriers. When you're on the road, you're
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connected to your phone, you're taking orders,
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you have to be aware of your surrounding. Now
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all of that is very tiring in itself. All that
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fatigue and everything builds up can lead to
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a fatigue in decision making. It's essential
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to improve working conditions and it's essential
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to take breaks at intervals. Delivery drivers,
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truckers, anyone who's spending time on the road,
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they really have to take breaks. So now we're
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going to talk about all our workers who basically
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spend time in front of computer screens, long
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periods of time. It causes eye fatigue and that
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further on causes headaches. Now those headaches,
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they affect your overall ability to function
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and all of that is directly related to eye strain.
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You need to take breaks at regular intervals
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especially during these long shifts. And now
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we're going to talk about all those who need
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to be
aware. of cognitive fatigue. And these
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are all the decision makers. They can be CEOs,
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they can be team leaders on the floor, senior
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doctors, anyone in senior positions, basically
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looking after your team and working in high stress
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situations. Now all of this high stress job,
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this all increases your risk of strokes, of high
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blood pressure, of diabetes, and it also has
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effects on... cognitive decline that's when you
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start getting slower with age so you all need
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to be getting your checkups done regularly you
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need to make sure your biochemical markers are
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all normal but you've also got to realize that
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all the time you're supposed to be asleep in
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bed that's the time when your body recovers and
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you're not getting that time for recovery so
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you have to take out your time and make sure
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you're getting that rest you've got to pay your
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sleep debt and that's it for the dispatch this
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month that's me Bilal With all the crickets all
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around me, I hope you're all doing well and have
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a good day. Thank you, Dr. Bilal. Our listeners
00:13:41.750 --> 00:13:44.570
can also participate in this segment. All they
00:13:44.570 --> 00:13:46.929
have to do is send their questions by email.
00:13:47.490 --> 00:13:50.389
But we clarify that this segment does not replace
00:13:50.389 --> 00:13:54.370
a physician's consultation. That's all for today.
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And until next week, I'm Erin Rogers signing
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off. Technical support for this show is provided
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by Vahab Shahid. Podcast logo, theme music, creative
00:14:07.039 --> 00:14:09.500
and production advice is given by Imran Babur.
00:14:09.720 --> 00:14:12.659
Aaron Rodgers is our editorial associate. Population
00:14:12.659 --> 00:14:14.879
Health Weekly is led by its listeners and they
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are invited to participate in any competent way
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they can. If interested, email us at info at
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