E-DRUG: Millions for Viagra, Pennies for the Poor (cont)
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Comment on companies' motives:
Needless to say, Pfizer's, Merck, Sharp and Dohme's and SmithKline
Beecham's fight against trachoma, onchocerciasis, and lymphatic
filariasis, respectively, is extremely fortunate for anybody
suffering from these diseases.
All drug companies should be encouraged to do something similar.
Personally, I am waiting eagerly to see which company will start
providing quality anti-TB drugs free of charge to all National TB
Programmes.
On the other hand, we should not underestimate the importance of a
strong brand name in business. It is my assertion that giving cheap
drugs for free for a good cause will repay many times the investment
in terms of improved reputation and promotion of the company brand
name.
If you are not convinced of this statement, you should look at the
top of page 269 in the well-recognized textbook "Lecture notes on
Tropical Medicine" by Dion R. Bell (4th edition, 1995, Blackwell
Sciences). There you will find the following free-of-charge
advertisement for Merck, Sharp and Dohme:
"By an act of extraordinary generosity, the manufacturer, Merck,
Sharp and Dohme have agreed to supply the drug [Ivermectin] free to
any government wishing to use it as part of an onchocerciasis control
programme."
Nobody can deny that this is extremely good promotion of a company.
The sincerest recommendation from respected authorities straight to
doctors and other key players in health. This kind of advertisement
simply cannot be bought for money, at least not directly.
The above is not meant as a negative criticism or insult to drug
companies, and indeed not to Dr Bell whose book is invaluable for so
many doctors. On the contrary, it is meant as an encouragement to do
more of the same; for public health because it makes drugs available
where it is needed, and for the company, because it is profitable
indirectly and in the long run. If a company want to have a solid
reputation on which to increase its wealth, this is the way to go.
Fortunately, in the mentioned instances, the results are good for
both parties, the sick get free drugs and the companies get more
money. There are numerous other examples of important drugs that
remain unavailable where they are most needed.
My conclusions are:
1) When it comes to business, it is irrelevant to talk of good and
bad motives. In the end it is the anticipated profit that guides ANY
decision taken by a commercial corporation, directly or indirectly.
This is in the nature of companies, and a company that claims not to
follow this principle is either dishonest or may end up in bankruptcy.
2) Apparent charity often turns out to be a well-invested
advertisement with long-term effects.
3) The only way to make a commercial company conduct genuinely
unprofitable activities (such as paying tax) is by government
regulation. Thus we should appreciate the necessity of both elements,
private initiative and public regulation. We need the industry to
discover new products and make them available. However, if we really
want to direct the enormous forces of the industry away from
anti-wrinkle creams and male potency-enhancing remedies, towards some
real health problems such as malaria or TB, we need governments
willing and able to regulate the activities. This cannot, and should
not, be the responsibility of the companies themselves, as these
institutions are designed for profit, not for charity. It is the
responsibility of governments to ensure sound directions in health
investments.
4) Sometimes genuine improvements of public health do happen as a
result of companies' profit-guided decisions as in the
above-mentioned examples. Both the drug industry and public health
advocates should become better in identifying those opportunities
where commercial and public health interests coincide and benefit
from the same activities.
5) Governments can do something good for public health by actively
using regulations to make it profitable for companies to make drugs
available for low-income countries. Examples include (relative)
tax-relief if companies donate drugs or conduct research on
third-world health problems, prolonged patent period in high-income
countries if companies donate/ sell the drug at low-price in
low-income countries etc. However, this requires commitments
(sacrificing tax revenues, increasing spending on patented drugs
etc.) from high-income countries' that may not be present.
Best regards,
Bjorn Blomberg, MD
Geneva
Email: blombergb@who.ch [added by moderator; WB]
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