Good morning, Hank, it's Tuesday.

So a couple weeks ago, some folks presented a tuberculosis research study at a conference that got a standing ovation, and I think it has implications, not only for TB treatment, but also for how we can speed up innovation around treating other diseases from malaria to cancer.

Okay, so to cure tuberculosis, you need to take a cocktail of antibiotics because the bacterium that causes it—Mycobacterium tuberculosis—is notoriously hard to kill. And for people with multidrug-resistant tuberculosis, TB that doesn't respond to the first line of antibiotics, if they're "lucky" enough to get treated at all, they have to take a regimen that lasts between 18 and 24 months. And that cocktail of drugs includes injectable medications that are so toxic and painful that one TB survivor described them to me as having an injection of lava into your body. Patients could expect to take around 13,000 pills in addition to the injections. All of this, the sheer number of pills, the serious side effects, the 18-month long treatment, means that many people are unable to finish their treatment and die as a result. And when you add that to the fact that most people with MDR TB are never even able to access accurate diagnostics or effective treatments, you get the catastrophe that we have now where only around 10% of people with multidrug-resistant tuberculosis are cured.

Now in the last few years, a much better regimen has emerged that works for many people. It requires only five pills per day. It's becoming a more affordable regimen, but it's still relatively expensive and it also involves a drug that is not widely available in many poor countries. Plus, you can't take it if you're a kid or pregnant. Enter the standing ovation: endTB trials. So for the last several years, Partners in Health, Doctors Without Borders, Unitaid, and other organizations have been working together on a randomized control trial to test if it's possible to cure MDR TB with shorter regimens using existing drugs. So in seven countries around the world, they they gave some people the existing 18-month standard of care and other people one of five new regimens lasting just nine months. And what they found is that three of those regimens achieved similar or slightly better cure rates after 9 months than the standard regimen does after 18 months, and one achieved significantly better cure rates after 9 months than the 18-month regimen—with around 90% of people being cured of MDR TB. The two best regimens were also pretty safe and as a little bonus, the least expensive. So no toxic injectables, 9 months instead of 18 months, better cure rates for less money.

Currently, the 18-month regimen costs about $5,000 per person. The two best 9-month endTB regimens cost about $300 per person. And some of that is because Johnson & Johnson is not pursuing secondary patents on bedaquiline, which is in part thanks to you Nerdfighteria. So we have better, shorter, safer, cheaper cures for multidrug-resistant tuberculosis as a result of this trial. Now, hopefully, the WHO will recommend these new shorter regimens soon, meaning more people surviving MDR TB and less overall MDR TB in the world. But also, the WHO should know that if they don't recommend these new regimens quickly, uh, we and other groups of TB activists and survivors will be knocking on their door quite incessantly.

What's most interesting to me about the endTB trial is that they weren't trying to prove that some new patentable compound would change everything and make billions of dollars. They were using existing drugs, albeit some that were quite new, in innovative combinations. And that's the kind of trial that drug companies just don't have much incentive to create. We see this in cancer treatment too. There is always incentive to create trials around new compounds that are patentable, but when it comes to using existing compounds in different combinations or at different dosages in order to increase cure rates, that's much harder to get money for.

1.6 million people are gonna die of TB this year and yes, we need to invest in new drugs and new drug classes and new treatments, but also 1.6 million people are going to die this year and they can't wait for those new compounds. They need drugs that are here now, and the endTB trial says to them there is hope for you. We need to do a better job of funding that kind of trial, now, in the world of cancer, public money and private donations have funded many of those experiments, but we need more. And with neglected diseases like TB, we need massive investment. The endTB trials could have started a decade ago and we'd already be at a point where for years, we'd known about these new 9-month regimens that are just as or more effective. We could have saved so much needless suffering and death by finding these better, safer, faster cures that, oh by the way, are also much less expensive. The endTB trials are not gonna make any one individual a billion dollars, but they are going to make all of humanity less poor and less sick.

Hank, I'll see you on Friday.