E-DRUG: Millions for Viagra, Pennies for the Poor
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[thanks to JL for forwarding this. Reproduced as fair use. WB]
The Toronto Star, Friday 13 August 1999
HEADLINE: MILLIONS FOR VIAGRA, PENNIES FOR THE POOR
Ken Silverstein SPECIAL TO THE STAR
One old, fat, bald, fungus-ridden rich man who can't get it up means more to
the pharmaceutical industry than half a billion poor people
vulnerable to malaria.
And almost three times as many people - most in tropical areas of the
Third World - die of preventable, curable diseases as die of AIDS.
Malaria, tuberculosis, acute lower respiratory infections claimed 6.1 million
lives in 1998. People died because the drugs to treat those illnesses are non-
existent or are no longer effective. They died because it doesn't pay to keep
them alive.
Only 1 per cent of all new medicines brought to market by multinational
pharmaceutical companies between 1975 and 1997 were designed specifically to
treat tropical diseases plaguing the Third World. In numbers, that means 13
out of 1,223 medications.
Certainly, the majority of the other 1,210 new drugs help relieve suffering
and prevent premature death, but some of the hottest preparations
have nothing to do with matters of life and death. They are lifestyle
drugs - remedies that may one day free the world from the scourge of
toenail fungus, obesity, baldness, face wrinkles and impotence.
The market for such drugs is worth billions of dollars a year and is one of
the fastest-growing product lines in the industry.
Western interest in tropical diseases was historically linked to colonization
and war, specifically the desire to protect settlers and soldiers.
Yellow fever became a target of biomedical research only after it began
interfering with European attempts to control parts of Africa. ''So obvious
was this deterrence . . . that it was celebrated in song and verse by
people from Sudan to Senegal,'' Laurie Garrett recounts in her
extraordinary book The Coming Plague. ''Well into the 1980s
schoolchildren in Ibo areas of Nigeria still sang the praises of
mosquitoes and the diseases they gave to French and British
colonialists.''
U.S. military researchers have discovered virtually all important malaria
drugs. Chloroquine was synthesized in 1941 after quinine, until then
the primary drug to treat the disease, became scarce following
Japan's occupation of Indonesia.
The discovery of Mefloquine, the next advance, came about during the
Vietnam War, in which malaria was second only to combat wounds in
sending U.S. troops to the hospital. With the end of a ground-based
U.S. military strategy came the end of innovation in malaria
medicine.
The Pharmaceutical Research and Manufacturers of America (PhRMA) claimed in U.
S. newspaper ads early this year that its goal is to ''set every last disease
on the path to extinction.'' Spokesperson Jeff Trewhitt says U.S.
drug companies will spend $24 billion on research this year and that
many firms are looking for cures for tropical diseases. Some
companies also provide existing drugs free to poor countries, he
says.
The void is certainly at hand. Neither the pharmaceutical manufacturers
association nor individual firms will reveal how much money the companies
spend on any given disease - that's proprietary information. But on
malaria alone, a recent survey of the 24 biggest drug companies found
that not a single one maintains an in-house research program, and
only two expressed even minimal interest in primary research on the
disease.
''The pipeline of available drugs is almost empty,'' says Dyann Wirth of the
Harvard School of Public Health, who conducted the study. ''It takes five to
10 years to develop a new drug, so we could soon face (a strain of)
malaria that's resistant to every drug in the world.''
A 1996 study presented in Cahiers Sante, a French scientific journal, found
that of 41 important medicines used to treat major tropical diseases,
none was discovered in the '90s and all but six were discovered
before 1985.
'The only thing (drug) companies think about is the price of their stocks'
Contributing to this trend is the wave of mergers that has swept the industry
over the past decade. Merck alone now controls almost 10 per cent of the world
market.
''The bigger they grow, the more they decide that their research should be
focused on the most profitable diseases and conditions,'' one industry watcher
says. ''The only thing the companies think about on a daily basis is the price
of their stocks. And announcing that you've discovered a drug (for a tropical
disease) won't do much for your share price.''
That comment came from a public health advocate, but it's essentially seconded
by industry. ''A corporation with stockholders can't stoke up a laboratory
that will focus on Third World diseases, because it will go broke, ''
says Roy Vagelos, the former head of Merck. ''That's a social problem
and industry shouldn't be expected to solve it.''
Drug companies, however, are hardly struggling to beat back the wolves of
bankruptcy. The pharmaceutical sector racks up the largest legal profits of
any industry and it is expected to grow by an average of 16 to 18 per
cent over the next four years, about three times more than the
average for the Fortune 500.
''It's obvious that some of the industry's surplus profits could be going into
research for tropical diseases,'' says a retired drug company executive, who
wishes to remain anonymous. ''Instead, it's going to stockholders.''
And to promotion ($10.8 billion on advertising in 1998). And to politics.
(American drug companies spent $74.8 million in 1997 to lobby the U.S.
government. Last year they spent nearly $12 million on campaign
contributions.)
Just 45 years ago, the discovery of new drugs and pesticides led the
World Health Organization to predict that malaria would soon be
eradicated. By 1959, Garrett writes in The Coming Plague, the Harvard
School of Public Health was so certain that the disease was passe
that its curriculum didn't offer a single course on the subject.
Resistance to existing medicines - along with cutbacks in health care budgets,
civil war and the breakdown of the state - has led to a revival of malaria in
Africa, Latin America, Southeast Asia and, most recently, Armenia and
Tajikistan. The World Health Organization describes the disease as a leading
cause of global suffering.
For the drug companies, the meagre purchasing power of malaria's victims
leaves the disease off the radar screen.
Among the problems the pharmaceutical companies are scrambling to eradicate
are:
Impotence. Pfizer invested vast sums to find a cure for what Bob Dole
and othe rindustry spokespersons delicately refer to as ''erectile
dysfunction.'' The company hit the jackpot with Viagra, which racked
up more than $1 billion in sales inits first year on the market. Two
other companies, Schering- Plough and Abbott Laboratories, are
rushing out competing drugs.
Baldness. The top two drugs in the field, Merck's Propecia and Pharmacia &
Upjohn's Rogaine had combined sales of about $180 million in 1998.
Toenail fungus. With the slogan ''Let your feet get naked!'' as its battle
cry, pharmaceutical giant Novartis recently unveiled a lavish
advertising campaign for Lamisil, a drug that promises relief for
suffers of this unsightly malady. The war against fungus involves a
market estimated to be worth hundreds of millions of dollars a year.
Face wrinkles. Allergan earned $90 million in 1997 from sales of its
''miracle'' drug Botox. Injected between the eyebrows at a cost of
about $1, 000 for three annual treatments, Botox makes crow's feet
and wrinkles disappear. ''Every 7 1/2 seconds someone is turning
50,'' a wrinkle expert told the Dallas Morning News in an article
about Botox last year. ''You're looking at this vast population that
doesn't want frown lines.''
Meanwhile, acute lower respiratory infections go untreated, claiming about 3.
5 million victims per year, overwhelmingly children in poor nations.
Such infections are third on the chart of the biggest killers in the
world; the number of lives they take is almost half the total
reaped by the Number One killer, heart disease, which usually strikes
the elderly.
In some cases, older medications thought to be unnecessary in the First World
and commercially unviable in the Third have simply been pulled from the
market.
This created a two-year crisis recently when TB re-emerged with a vengeance in
U.S. inner cities, since not a single company was still manufacturing
Streptomycin after mid-1991.
All the blame for the neglect of tropical diseases can't be laid at the feet
of industry. Many Third World governments invest little in health
care, and First World countries have slashed both foreign aid and
domestic research programs. Meanwhile, the U.S. government
aggressively champions the interests of the drug industry abroad, a
stance that often undermines health care needs in developing
countries.
Given the industry's profitability, it's clear the companies could do far
more. It's equally clear that they won't unless they are forced to.
While the industry's political clout currently insures against any radical
government action, even minor reforms could go a long way.
At the beginning of this year, Doctors Without Borders unveiled a campaign
calling for increased access to drugs needed in Third World countries. It's
exploring ideas ranging from tax breaks for smaller firms engaged in research
in the field, to creative use of international trade agreements, to
increased donations of drugs from the multinational companies.
Campaign organizer Dr. Bernard Pecoul says different approaches are required
for different diseases. In the case of those plaguing only the
Southern Hemisphere- sleeping sickness, for example - market
mechanisms won't work because there simply is no market to speak of.
He suggests that if multinational firms are not willing to manufacture a given
drug, they transfer the relevant technology to a Third World producer that is.
'If we can't change the markets, we have to humanize them'
Drugs already exist for diseases that ravage the North as well as the South -
AIDS and TB, for example - but they are often too expensive for people in the
Third World.
For 25 years, the World Health Organization has used funding from member
governments to purchase and distribute vaccines to poor countries. Pecoul
proposes a similar model for drugs to treat tropical diseases.
Another solution he points to: In the event of a major health emergency, state
or private producers in the South would be allowed to produce generic versions
of needed medications in exchange for a small royalty paid to the
multinational license holder.
''If we can't change the markets, we have to humanize them,'' Pecoul says.
''Drugs save lives. They can't be treated as normal products.''
Reprinted with permission from The Nation.
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