E-drug: Response to the article in the Globe and Mail (2)
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Here is the contents of my response to the Wainberg article that
appeared last week in the Globe and Mail, one of Canada's two national
newspapers.
According to Dr. Mark Wainberg if multinational drug companies are
forced to cede their patents on drugs to fight AIDS then it "would spell
the end of new drug development for HIV." The implication here is that
the pharmaceutical industry has been the main force behind the new
medications for this disease. But the reality is much different. The
U.S. government and its agencies have played a key role in the
development of most of these drugs. AZT, the first drug, used for AIDS
was discovered by the National Cancer Institute. Public research
institutes have heavily funded anti-retroviral development including
that for didanosine, abacavir, stavudine and zalcitabine. "The concept
and feasibility of protease inhibitors grew in part out of
NIAID-supported basic research" said Dr. Anthony S. Fauci, director of
the National Institute of Allergy and Infectious Diseases.
Would the drug companies suffer financially if they lost their markets
in countries in Africa, Asia and South America to generic producers?
Would it kill their incentive for further investment in this area as
Wainberg states? Will they be donating their profits? The answer is no.
The current standard of "triple therapy" costs US $10,000 per year
putting it far beyond the means of most people in Third World
countries. At most, sales in this part of the world amount to a few
percent of the total income that the multinational companies get from
their AIDS drugs.
Wainberg is correct when he says that generic are out to make a profit
the same as the multinational companies. However, they can produce
drugs for AIDS at a fraction of the cost of the multinationals and
still
thrive. One generic producer recently told James Love, director of the
Washington-based Consumer Project on Technology, that with large
production runs it would be possible to produce drugs such as AZT for
about 5 cents per pill, or 21 cents per day. A group of five
multinational companies has proposed to drop its prices for AIDS drugs
for developing countries by 80%. That would bring the cost of triple
therapy down to a "mere" $2000 per year. Still far beyond what most
people in places like SubSaharan Africa can afford. The generic
company that Love talked to thought that it could produce a triple
therapy regime for about 63c per day, or about $230 per year.
The production of generic antiretrovirals in India and Thailand has
increased access to treatment for AIDS. In a recent article in the
medical journal The Lancet M�decins Sans Fronti�res pointed out that
Brazil has been able to afford to put 90,000 people with AIDS on
combination therapy because generic competition has reduced prices of
antiretrovirals by more than 70% during the past 5 years. Other
developing countries that do not have the capacity to develop a generic
industry could import drugs from India, Thailand or Brazil.
Finally, Dr. Wainberg failed to disclose that he might have a conflict
of interest in this debate. He has received grant support from
Bristol-Myers Squibb, Glaxo Wellcome, and Boehringer
Ingelheim, all multinational companies with AIDS drugs. His laboratory
helped to develop the AIDS drug 3TC and he owns shares in BioChem
Pharma which makes the drug.
Joel Lexchin MD
121 Walmer Rd.
Toronto, Ontario
Canada M5R 2X8
T: +416-964-7186
F: +416-923-9515
e mail: joel.lexchin@utoronto.ca
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