E-drug: In Defense of Al Gore- Just This Once
------------------------------------------------------------------
[copied from PHARM-POLICY with thanks]
This is distributed as a fair use under US copyright law. Jamie
http://www.weeklystandard.com/editorial.html
Editorial 7.19.99
In Defense of Al Gore- Just This Once
David Tell, for the Editors
Thirty-three million human beings across the globe already show
the symptoms of AIDS or are infected with the HIV virus. Two
thirds of them live in sub-Saharan Africa-more than 25 times
the number of cases accounted for by Canada, Mexico, and the
United States combined. In Africa the infection continues to
spread, virtually unchecked. South of the Sahara, 4 million new
HIV/AIDS diagnoses are made each year, more than 90 times
the North American figure. And the situation is particularly
acute in the emerging democracy of South Africa, where the
population-wide incidence of HIV is approaching 10 percent,
including 35 percent of all pregnant women and nearly half of all
active-duty military personnel. As things currently stand, the
vast majority of these people, millions of them, seem doomed to
die.
So for almost two years now, the government of South Africa has
been attempting to implement amendments to its Medicines Act
that would make possible the procurement and distribution, in
low-cost, generic form, of otherwise prohibitively expensive but
potentially life-preserving anti-retrovirus therapies developed
in the United States. But for just as long, concerned that the
amendments as drafted might expropriate the patent rights of
U.S. pharmaceutical companies, the Clinton administration has
sought modification or outright repeal of the South African
legislation.
All of which-the bilateral intellectual property dispute,
narrowly, and the cataclysm of HIV in Africa, more broadly-has
failed to win high-profile attention in America. Until this
spring. In April, the "Consumer Project on Technology," one of
the many tentacles of the Ralph Nader octopus, began publicizing
a State Department report that "revealed" the participation of
Vice President Gore in diplomatic negotiations with South Africa
over the Medicines Act amendments. And in short order, AIDS
activists began disrupting Gore's public appearances, chanting
"Gore is Killing Africans!" for benefit of the network television
cameras.
Subsequent, objective news analyses of the underlying controversy
have been sketchy at best. But two well-known opinion
journalists-John B. Judis, on the left, and Arianna Huffington,
on the right-both claim to have investigated the question. And,
surprisingly, both have wholeheartedly endorsed the basic
activist complaint against Gore.
In an essay in the current American Prospect, Judis dubs the vice
president "K Street Gore," and attributes his "weak and morally
repugnant" hesitancy about generic AIDS drugs in South Africa
to an "interlocking directorate" of Gore advisers with ties to
the U.S. pharmaceutical industry lobby. On "issues that impinge
upon his high-tech network of supporters," Judis concludes, Gore
has here proved "willing to do the wrong thing to keep them
happy-and keep them in his corner" with financial contributions.
Arianna Huffington offers the exact same judgment, though still
more sharply. "Pharmacologic Al," she writes in her nationally
syndicated column, has allowed "powerful special interests to
secretly dictate policy-even when the life or death of millions
is at stake." The provision of modern AIDS medications to South
Africa is "one of those rare issues-such as child abuse and drunk
driving-on which there cannot possibly be two sides" of equal
virtue. South Africa must have the drugs.
In other words, according to this commentariat odd couple, Al
Gore, by preventing South Africa from obtaining the drugs
immediately, really is killing Africans. Which raises two
questions. One: Is such a remarkable savaging of the vice
president fair? And, two: Fair or not, does the spectacular
bloody-hands charge against Gore at least represent welcome
public awareness of a long-under appreciated international
humanitarian emergency?
On the first score, the answer is no. The suggestion that the
vice president has passively condemned impoverished South
Africans to hideous death by contagion-in exchange for
corporate-backed campaign donations-is not even remotely
fair. It is groundless and grotesque.
U.S. pharmaceutical companies stand to lose a fortune on their
patented medications if foreign governments start unilaterally
authorizing the manufacture or importation (from "gray market"
countries like India) of cheap knock-offs-as South Africa has
announced it intends to do in this case. And these losses, the
companies point out, pose a more than financial risk. It
sometimes costs hundreds of millions of dollars to discover,
test,
and start distributing a desperately needed new medicine. If
originating American laboratories are no longer permitted to
recover these mammoth investments with profits protected by
patents that are respected internationally, then they may well
dramatically scale back their research and development efforts.
On future AIDS therapies, for example.
This is a far from stupid argument, and it seems to have fully
persuaded certain major players in the Clinton administration.
But it turns out, on close inspection, that the vice president
isn't exactly one of them.
Gore's staff-which will patiently explain all the trade-law
technicalities to anyone who bothers to call-is appropriately
cognizant of the value of American pharmaceutical patent rights,
and remains intent to ensure that South Africa not totally ignore
its treaty obligations to observe those rights. But Gore has
otherwise declined to do the pharmaceutical industry's "bidding,"
as the cartoon criticism of him would have it. Earlier this year,
during interagency meetings, he successfully opposed an
industry-backed plan to target South Africa with trade reprisals.
Calm, continued negotiations, the vice president thought, were a
better idea. And two weeks ago, in a letter to the Congressional
Black Caucus, Gore explicitly confirmed his willingness, given
the health crisis in Sub-Saharan Africa, to consider any
well-designed effort "to speed the availability of lower-cost
pharmaceuticals in South Africa," including generics.
Al Gore, in short, stands falsely accused of obstinately
resisting a public health initiative he doesn't necessarily
resist at all.
Happy ending, then? Could it be that from this recent media
eruption-despite the cruel slanders to which it has subjected the
vice president-a previously unrecognized political consensus has
emerged that the widespread introduction of anti-retroviral
medications is the obvious solution to the African AIDS epidemic?
And that the only remaining question is precisely how to do it?
Here, too, alas, the answer must be no. Because for every
prominent physician who favors the distribution of advanced
AIDS drugs in Africa, there is another prominent physician who
views the idea with something close to horror. And the doubters'
warnings cannot be blandly dismissed.
The modern, multi-drug anti-AIDS "cocktail" now so common
in the industrialized world is a fiendishly tricky therapy. You
must take your pills on a strict schedule. You must take some
before meals, some after. Some medications must be refrigerated,
some not. Depart from the prescribed regimen even a bit, even for
a single day, and a new strain of HIV may quickly spread
throughout your body. If you then infect some other poor soul,
his virus may prove resistant-from the onset-to most or all known
anti-retrovirus compounds. This is not a theoretical problem. It
is happening already in the United States.
And in Sub-Saharan Africa, including South Africa, where public
health systems competent safely to deliver, administer, and
supervise such an inherently risky medical intervention are sadly
nonexistent, the standard American AIDS cocktail might thus
wind up saving no one, and make the epidemic even less
manageable.
Throughout the whole of Africa, non-AIDS infectious
diseases-pneumonia in infants and children, malaria and
tuberculosis in adults-also take huge numbers of lives each year.
These diseases are more easily diagnosed and treated than
AIDS. AIDS is more dramatic, however, and so organized efforts
to deal with such "minor" infections go starving for
international funding, even where the purchase of relatively
simple, non-patent antibiotics is concerned.
By largely ignoring this separate crisis, and insisting instead
on a questionable HIV-specific intervention, are the vice
president's critics themselves "killing Africans?" Someone might
say that. But we would not. No American is "killing Africans."
Infectious diseases are killing Africans. And while all men of
good will agree that something must be done, the horrible truth
remains that it's difficult responsibly to assert that we know
just what that something is.
In the current fracas, it seems to us, Vice President Gore is
attempting to keep all reasonable considerations in balance. He
wants his country to sustain in principle the international
patent-protection regime. He wants to foreclose no potentially
effective response to the infectious-diseases crisis in Africa.
And he declines to endorse the dangerous fantasy that a perfect
response has already been identified. We are pleased to say-and
we may never say anything like this again-Al Gore is doing the
right and honorable thing.
--
Send mail for the `E-Drug' conference to `e-drug@usa.healthnet.org'.
Mail administrative requests to `majordomo@usa.healthnet.org'.
For additional assistance, send mail to: `owner-e-drug@usa.healthnet.org'.