Date of this Version
Baird in the New England Journal of Medicine (2008) 359).
Wellems and Miller wrote of two worlds of malaria: one, of the residents of rural tropical areas in which the disease is endemic, and the other, of travelers to those areas, who typically have greater resources. The distinction is sharp, valid, and important in considering the development of tools to combat the global burden of malaria. Drugs considered safe and effective in one world may not be so in the other. The majority of the hundreds of millions of people in whom malaria will develop over the next year will obtain and consume antimalarial medication without medical supervision. Although the licensing of complex or poorly tolerated therapeutic regimens requiring clinical screening for contraindications may be perfectly suitable for populations with access to close clinical supervision, distributing the same regimen in the rural tropics is reckless.