E-drug: Article from the globeandmail.com Web Centre
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This op ed article appeared in yesterday Globe and Mail, one of
Canada's two national newspapers. I would be happy to collaborate in
a response but would like to do so with someone who has followed this
issue more closely than me.
Joel Lexchin MD
121 Walmer Rd.
Toronto, Ontario
CANADA M5R 2X8
Phone: +416-964-7186
Fax: +416-923-9515
e mail: joel.lexchin@utoronto.ca
The Globe and Mail, Thursday, August 17, 2000
We can't handicap a cure
Removing patent protection from AIDS drugs will hurt, if not kill,
any incentive to invest in more research
By Mark Wainberg
Within the next few years, HIV will become the world's leading cause
of death, a grim fact highlighted by the International Conference on
AIDS held recently in Durban, South Africa. More than 35 million
people are now thought to be infected by the virus. The vast majority
reside in the countries of sub-Saharan Africa, where access to
anti-HIV drugs is severely limited for reasons of cost. Many world
leaders have argued for the elimination of patent protection for
anti-HIV drugs, so that generic drug manufacturers might make these
products available at greatly reduced costs to the benefit of
millions.
I believe that eliminating patent protection would, over time, have
the exact opposite effect. The reality is that the pharmaceutical
industry has invested many millions of dollars toward the development
of the drugs now used to fight AIDS. Yet none of these compounds --
even when used in the current cocktail approach in which three or
more drugs are combined -- is ideal. Most patients who have taken
these drugs for three or more years have developed resistance to at
least one of them. No one can promise the patients who currently
enjoy drug access that they will live out full lives.
Indeed, many scientists believe that the problems of prolonged
adherence to complicated drug regimens (in which patients must often
take medicines two or three times a day for life), the long-term
toxicity of these drugs, and problems of resistance will lead to
treatment failure in a high proportion of cases over time. This
prediction underlines our need to continue to develop newer and
better drugs to combat HIV -- drugs that won't be prone to the same
problems that plague the medicines that are now the most commonly
prescribed.
Those who advocate the elimination of patent protection for the drugs
in current use should understand that their ideas, if successful,
would spell the end of new drug development for HIV.
Think about it: What possible incentive could exist for further
investment in this area if pharmaceutical companies understood in
advance that they would never enjoy patent protection for products
that had cost tens of millions of dollars to develop? Who would do
the research necessary to bring further advances to the benefit of
HIV-infected people around the globe, regardless of socio-economic
status?
Certainly, this burden would not be assumed by the generic drug
industry -- a sector that attempts to portray itself as altruistic,
but, in reality, invests precious little into either research or
medical-education programs designed to help stop the spread of HIV.
The reality is that generic drug manufacturers price their products
at the highest possible levels, relative to brand names, to secure
profits, without having done any of the research needed to develop
these drugs in the first place. Far from being public-spirited and
philanthropic, generic drug manufacturers are simply businessmen who
use the inventions of others to acquire personal profit.
There's no other industry in the world in which the pressures to
willingly surrender patent protection are so blatant. While all of us
lament the fact that global disparities exist in regard to drug
access, why should pharmaceutical companies be asked to bear a
disproportionate share of the burdens of global inequality? After
all, are manufacturers of other types of products, such as
automobiles, airplanes, appliances, or foodstuffs, expected to offer
their goods and services to developing countries at reduced prices
because of an inability to pay?
Of course not. Nor are companies that reap huge profits by selling
their wares to developing countries -- such as arms manufacturers --
compelled to donate their profits back to those countries in the form
of aid for education or access to cheaper drugs. Somehow, the world
has erected a double standard in regard to expectations from
pharmaceutical companies versus everyone else. Because drugs offer an
immediate hope of prolonged life in the case of people infected by
HIV, it's concluded that such medicines should be made available by
their manufacturers at cost, without regard for the impact this would
have on future drug development.
In reality, access to drugs for all who need them should, indeed, be
a right for all and not a privilege of those who live in rich
countries. But the responsibility to bring this about should not be
borne in disproportionate fashion by the brand-name pharmaceutical
industry.
We have to recognize that the manufacturers of brand-name drugs have
tried to respond to the question of improved drug access through a
number of innovative programs. First, Boehringer-Ingelheim, the
manufacturer of a drug called Nevirapine, has pledged to give its
product away for free to African countries for prevention of
mother-to-child transmission of HIV. Studies have shown that
Nevirapine can be used in a cost-effective way for this purpose,
costing only $6 when given to HIV-infected pregnant women at the
onset of labour.
In addition, Glaxo Wellcome, Bristol-Myers Squibb, Merck, Roche, and
Boehringer-Ingelheim have all indicated their desire to offer
anti-HIV drugs to developing countries at discounts of as much as 80
per cent off the costs of these products in the developed world.
These initiatives should convince the public that
pharmaceutical-industry executives are as troubled as anyone by the
global inequalities that the HIV epidemic has starkly brought to
public attention.
Whether or not these intentions can quickly be implemented remains to
be seen. But it would be cynical for anyone to conclude that the
companies are not sincere in wanting to make a difference for the
vast majority of HIV-infected persons in developing countries. And
it would be naive to think that generic companies are motivated by
anything other than short-term opportunism in wanting to overturn the
system of patent protection for anti-viral drugs.
Dr. Mark Wainberg, director of the McGill University AIDS Centre, is
the immediate past president of the International AIDS Society. He
will chair the International AIDS Conference scheduled for Toronto in
2004.
Copyright 2000 | The Globe and Mail
Joel Lexchin MD
121 Walmer Rd.
Toronto, Ontario
CANADA M5R 2X8
Phone: +416-964-7186
Fax: +416-923-9515
e mail: joel.lexchin@utoronto.ca
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