E-drug: Guardian & BBC: 5 January 2000 on WHO and drugs
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[copied as fair use; WB]
A bitter pill for the world's poor
Drugs companies do care for the suffering - if they have some cash
Isabel Hilton
Wednesday January 5, 2000, The Guardian
In a tiny village in Bihar, in northern India, a young man of 17 was
sitting outside his house. He was shaking and sweating profusely, the
whites of his eyes were yellow, and his spleen was found to be
enlarged. He was suffering from leishmaniasis, known once to the
British as dum dum fever and today in India as kalaazar. Untreated,
the illness attacks the immune system until the victim succumbs to
some opportunistic infection - most likely tuberculosis - and dies.
The young man had tried to get treatment, despite his family's
poverty. His father was a rickshaw puller, so every penny the family
had was laboriously earned. They had spent several months' income
on treatment, but the young man had been given a drug that had lost
its effectiveness. Now there was no money and no more treatment.
It is a story repeated daily in towns and villages across the developing
world. Whatever the recorded cause of death - leishmaniasis,
tuberculosis, pneumonia - the real cause is poverty. Poor people in
tropical countries are at risk from a range of diseases for which they
cannot get treatment - either because medicines are available at prices
they cannot afford or, worse still, because no medicines are available.
The most common treatments for leishmaniasis were discovered by
British doctors in the closing years of British rule. They applied their
minds to leishmaniasis because they needed to keep their soldiers
healthy. For the same reason, the US invested in malaria research
during the Vietnam war. But when there is no pressing military or
colonial imperative, the developed world loses interest in tropical
diseases. Multinational pharmaceutical companies neglect the diseases
of the tropics, not because the science is impossible but because
there is, in the cold economics of the drugs companies, no market.
There is, of course, a market in the sense that there is a need: millions
of people die from preventable or curable diseases every week. But
there is no market in the sense that, unlike Viagra, medicines for
leishmaniasis are needed by poor people in poor countries.
Pharmaceutical companies judge that they would not get sufficient
return on research investment, so why, they ask, should we bother?
Their obligation to shareholders, they say, demands that they put the
effort into trying to find cures for the diseases of affluence and
longevity - heart disease, cancer, Alzheimer's. Of the thousands of
new compounds drug companies have brought to the market in recent
years, fewer than 1% are for tropical diseases.
We could just shrug, of course, and say that's what you get for being
poor. Or, if we were feeling more charitable at the dawn of the new
millennium, we could post off a batch of (probably outdated)
medicines and feel better. The companies have their own equivalent of
those care packages in donation programmes - short-term gestures
that look good in the annual report. They can also be cited to
counterbalance charges of neglect or of dumping drugs in developing
countries that cannot be marketed where regulation is more stringent.
(That is so widespread that there is a grim little joke in the industry: if
there are no side effects, they say, it must be Honduras.) The trouble
with charitable gestures is that they are only gestures. If we want to
have an effect, something more systematic is required.
Why should we? Because, as the economist Jeffrey Sachs points out,
it is no good waiting for developing countries to attain the degree of
affluence that would allow them to buy themselves an effective health
service, equipped with the medicines we take for granted. The fact is
that ill health in tropical countries is a huge drag on development, and
without intervention in health, other aid is the less effective.
And who should intervene? The pharmaceutical companies have the
capacity to do so, as well as a moral debt that they have not begun to
pay. But it is unrealistic to suppose that they act without public
stimulus. The World Health Organisation has the public authority but
not the technical capacity. As a partnership, the industry and
international public health bodies could make a significant difference,
if they were prepared to set aside, respectively, corporate greed and
bureaucratic complacency.
There are signs of a change of approach at the WHO, as the impact of
the arrival of the former Norwegian prime minister, Gro Harlem
Bruntland, is felt. For the first time in years, the organisation is
displaying energy and initiative. How far this will go, though, will
depend on how the industry responds.
In the corporate headquarters of major drug companies, the public
relations posters display the image they like to present: of caring
companies that bring benefit to humanity, relieving the suffering of the
sick. What they don't say, is that, so far, their humanity has not
extended beyond the limits of the pockets of the sick.
Isabel Hilton's reports on pharmaceutical companies, The Bitter Pill,
are on Tuesdays on Radio 4, 8pm
UN Wire, 5 January 2000
HEALTH
DRUGS: International Companies Are Neglecting Poor -- BBC
Developing countries face a "health lottery" when drugs are not
available or are out of financial reach, according to a three-part series