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Pervasive ill health and overpopulation impede progress in most developing countries but in recent years, programs providing aid to these regions have de-emphasized health as a priority. Furthermore, support for building the health research capacity, so essential to the success of efforts to promote improved health, has been lacking. This paper examines these policies as they relate to one developing country, one global health program and a major Canadian development agency. Much has been achieved in the past decade in one of the world's poorest countries, Bangladesh, but major health problems persist, particularly in maternal and child health. With the will to build effective health programs, Bangladesh lacks the resources and the research base needed for their development. The World Health Organization, (WHO) Diarrhoeal Disease Control (CDD) program, which addresses a major cause of child mortality in Bangladesh, promotes effective treatment but it contributes little to a permanent research establishment in that country. The Canadian International Development Agency (CIDA) which directs only a small portion of its $2.2 billion annual budget to health, lacks an influential level of technical expertise in health. This agency has no mandate to support health research in the developing world; research is the responsibility of the International Development Research Centre (IDRC), the Health Sciences Division of which closed in July, 1995. To upgrade the place of health and health research in development, the attitudes and policies of major donors must change and models of success are needed. Of the existing institutions or programs involved in health and health research in the developing world, the internationally funded health research centre, strategically sited in the developing world could provide the excellence around which relevant programs should flourish. An existing example of this rare species, the International Centre for Diarrhoeal Disease Research, Bangladesh, merits particular consideration in this regard.

We conducted a phase I/II study in patients with advanced non-small-cell lung cancer (NSCLC) to increase the therapeutic index of the cisplatin–irinotecan combination by institution of an anti-late-diarrhoeal program (ADP). A total of 77 chemotherapy-naive patients with advanced NSCLC were enrolled. The cisplatin dose was fixed at 60 mg m −2 (Day 1). Irinotecan was escalated in 5 mg m −2 increments, starting from 60 mg m −2 (Days 1 and 8). ADP consisted of oral sodium bicarbonate, magnesium oxide, basic water, and ursodeoxycholic acid, and was administered orally for 4 days with each dose of irinotecan. In the phase I portion, irinotecan pharmacokinetics was also examined. After the recommended dose of irinotecan with ADP was determined, a phase II study was conducted to evaluate the response. Maximum tolerated dose was reached at an irinotecan dose of 80 mg m −2 (Grade 4 diarrhoea and neutropenia). Pharmacokinetic studies show that the maximum concentration and the area under the curve of both irinotecan and SN38 (active metabolite of irinotecan) tend to increase in the dose-dependent manner of irinotecan. The phase II portion of the study included 48 patients, who were treated with 75 mg m −2 of irinotecan. Grade 3/4 toxicities included neutropenia in 65%, leucopenia in 33%, and late diarrhoea in 6% of the patients. During this treatment, PS did not change in 65% of patients. At the end of the chemotherapy, PS did not decline in 90% of patients. In the phase II portion, a response occurred in 63% (95% confidential interval (CI), 47–76%) of patients. Median time to progression was 19 weeks (95% CI, 15–22 weeks), and median survival was 52 weeks (95% CI, 39–64 weeks). This regimen of irinotecan and cisplatin with ADP resulted in promising efficacy with acceptable toxicity for patients with advanced NSCLC. This regimen is a candidate for the experimental arm towards future phase III studies.