Editorial [Disparity in Pharmacotherapies]

The articles in this issue of Current Drug Therapy illustrate the spectrum of success in our attempts at pharmacotherapy. At one extreme we have a paper dealing with autism spectrum disorder, for which no therapies are available to deal with the underlying disorder (although some of the manifestations are amenable to treatment), to reviews of diseases for which a wide variety of treatments are available. These include reviews of treatments for AIDS and type 2 diabetes. An appealing explanation for this disparity in therapeutic options among disease states is that some disease processes are much more complicated than others, or that the organs which they affect are of different complexity. Certainly, the brain (autism) is more complex than immune cells and viruses (AIDS) and the pancreas (diabetes). Complexity of the disorder or body system affected probably does not totally explain why many more therapies are available in some situations than in others. What also appears to contribute to this disparity is the fact that the scope of pharmacological intervention is much more targeted in some situations that in others. For instance, in the case of AIDS, the goal is to affect the interaction between a virus and a cell, with targeted inhibition of viral replication. Similarly, diabetes can be thought of as an interaction between pancreatic cells, insulin and target cells. Here too, molecular mechanisms involved have been elucidated, and therapies are designed to correct these abnormalities. Autism, on the other hand, appears to involve complex interactions between multiple systems in the brain, many of which are still poorly understood. If we could understand abnormal interactions between individual groups of brain cells, preferably at the level of receptors, developing a successful therapy would be much more likely. The above is certainly an oversimplification of some of the disorders discussed. If one accepts the general concept however, it becomes clear that advances in pharmacotherapy are dependent largely on our understanding of underlying physiology and pathology.