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Agony of inaction

There are lots of therapy areas into which big pharma is unwilling to dip its toe.  I'm not what you'd call 'happy'. I have become a grumpy old man.

A grumpy old manI'm not what you'd call 'happy'. I have become a grumpy old man. Indeed, the star of the BBC's Grumpy Old Men is none other that my former near neighbour, Rick Wakeman. He has moved away now and I miss being able to be grumpy with him.

I do regret the passing of the simple things in life, such as manners, please, thank you, waiting in turn. Life before I know my rights; that placid time when kids managed to go to school without mugging an old lady on the way.

The halcyon days of television when you could watch with your mother without squirming at the bad language, state of undress and sweaty bodies rolling around in 'the love shack'.

Days when you could eat without having first to read the packet. Food that was sown, grown and harvested by farmers, instead of spun, formulated and created by technologists. The good old days when no one spat in the streets and left disks of gum welded to the footpath.

Days when it was possible to go to a pub on a Saturday night without having a drunken woman being sick on your shoes, or risk being beaten up by a pack of feral children.

I know, I know: I'm getting old and shouldn't expect the modern world to understand politeness, honesty and decorum. No doubt somewhere, out there, there is someone thinking that they have a perfect EU-given right, while sitting in a crowded railway carriage, to scream foulmouthed abuse down their mobile phone.  Or, indeed, use their hand-held while hurtling down the motorway at 90 miles per hour.

I am basically grumpy, fed up and hacked-off with the way the world is going. I think we are all heading for hell in a hand cart. Right now, I am especially grumpy. I am a crescendo of grumpiness. Grumpy for a crucial reason. I have an attack of the gout.

Gout: the shimmering exquisite pain that is gout, and gout alone. The swollen distorted agony that is my big toe. Gout: the shining polished, crimson skin that is gout. The hammering relentless pain that is gout. The pain that is beyond agony, beyond misery, beyond suffering. The eye-watering torture that comes in the small hours of the morning, grips the joint and squeezes, clasps and clenches it, relentlessly, every second of every minute of every hour of every day, in a vice of torment that is beyond words.

To blame the causes of gout on good living - a self inflicted wound of the middle-aged, middle classes - is to display an ignorance of the chemistry that conspires to visit the curse of gout upon the innocent, the fit, the active and the abstemious. Gout is a pain that makes toothache, earache and, dare I say, haemorrhoids a delight to have.

Gout: a discomfort that threatens the life of any innocent passer-by who might, unknowingly, move within 10 feet of my toe. If they were to disturb the air in the vicinity of my toe, they risk being the victim of a dreadful, awful, uncontrollable rage, fuelled by pain, despair and anguish.

The pharmaceutical industry, in all its glory, research, elegance and fat-cattery has no cure and no effective pain relief for gout, and has no interest in finding any. There are three pills that can be prescribed to reduce the cherry inflammation that is the hallmark of gout. Two are no longer used as they turn the patient's stomach into a lace hanky and the bowels to water.

The third is a pill that turns the stomach into a bonfire. In the longer term, there is a preventative pill that comes with a list of potential side effects as long as the EU constitution. No thanks. So, the industry that pays its boardroom squillions and pours more money into R&D than the total economy of most small countries has nothing meaningful for gout.

Grumpy old men - and some women - everywhere are abandoned to their fate. Outcast and exiled. I'm not happy. In the US, the number of gout sufferers has doubled in the last decade and in the UK, there are thought to be 250,000 victims. That is a quarter of a million people reduced to silent, private tears of anguish.

A quarter of a million people is roughly the population of Stoke-on-Trent, or Belfast; very nearly the equivalent of the population of Kingston-upon-Hull, plus, as the pharma industry is so boastful of its international pedigree, roughly the size of the population of Malmˆ in Sweden, or Verona in Italy.

A quarter of a million sufferers with a 10-day episode of gout means 2.5 million work days lost. What's the cost to the economy? No idea. Perhaps £150m. The cost to the individuals - who knows?

This cannot go on. Big pharma must focus its efforts on the plight of this onelegged army, hobbling and limping its way into the red-mist of misery that is uniquely gout.

For each sufferer there is a carer, a helper, some innocent bystander who is abused, cursed and humiliated for no reason other than they are in the vicinity; indeed, in the neighbourhood, perhaps even just the same county. For every gout casualty, there must be at least two other victims. Immediate family and friends who walk on eggshells, tip-toe around and hover - lest their very presence is detected by the gleaming, glowing, purple, throbbing joint.

There will be gaps in the workforce as the gout casualties leave their jobs and take refuge among feather-down cushions and beds. Economic inactivity; a slow down in the economy, work days lost as employment is abandoned. What is the real cost of gout? What is the real cost of other orphan illnesses:conditions abandoned by big pharma because there is no obvious answer and no obvious profit?

How many are there? Little illnesses that are devastating to the individual, collectively overwhelming to the economy and of no interest to pharma. Find out. Do something. There is a lot of it about!

Roy Lilley is a healthcare author and broadcaster. He has written several books and is well known for his sometimes controversial opinions

2nd September 2008


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