Folks,
this is from the The New Republic online. it should help explain why
multinational pharmaceuticals are loath to developing "cheap drugs" as they
put it for Aids carriers.
Hamjatta Kanteh
***********************************************************
Why cheap AIDS drugs for Africa might be dangerous.
Take Your Medicine
By SIDDHARTHA MUKHERJEE
Issue date: 07.24.00
Post date: 07.13.00
Last week's international aids Conference in Durban, South Africa, was a
spectacularly glum affair. While angry protesters outside the conference
railed against greedy pharmaceutical companies, delegates inside recited
dismal statistics about the plague, each more alarming than the last. In
South Africa, approximately one in ten adults is HIV-positive; in Africa as a
whole, aids now takes three times as many lives as the next most common cause
of death. Of all the depressing numbers, there was only one that health
officials felt confident about changing any time soon: the $15,000 it
currently costs to treat just one person with anti-HIV drugs for a year.
The reason is something called "tiered pricing" or "equity pricing," a
concept that UNAIDS, the United Nations agency dealing with aids, began
promoting recently and that elicited considerable excitement in Durban, even
winning the endorsement of Bill Gates. Under the scheme, Western
pharmaceutical companies, like Merck and Glaxo Wellcome, would set different
prices for drugs in rich and poor countries. The same pill--say, AZT--could
be sold for $4 in New York but only 40 cents in Johannesburg. With tiered
pricing, Africans could finally afford the anti-HIV medicines they
desperately need, and drug companies could still turn a reasonable profit.
A great idea? Actually, no--at least not by itself. What the enthusiasts seem
not to realize is that without adequate health care networks to monitor their
distribution, potent new medicines are worse than useless; they're dangerous.
Consider Russia's recent experience with anti-tuberculosis drugs. In the
1990s, physicians in the former Soviet Union unleashed a torrent of
anti-tuberculosis drugs on the population. The drugs were great, but the
patients taking them weren't adequately supervised; in many hospitals, as
many as 50 percent of patients strayed from the prescribed regimen. Soon,
upwards of five percent of patients in some Russian clinics began to exhibit
a strain of tuberculosis completely resistant to all drugs. Subsequently,
millions of dollars had to be spent to contain the deadly strain. As Dr. C.
Robert Horsburgh, a public health expert from Boston University, recently
warned in the Journal of American Medicine, "The genie of
multi-drug-resistant TB [was] irreversibly out of the bottle."
The HIV genie is even more ominous. HIV's secret--one reason the wispy virus
is now a continent-hopping Goliath--is that it mutates rapidly, quickly
becoming resistant to drugs. If anti-HIV drugs are not taken properly--a
missed capsule here, a forgotten pill there--a low level of viral
reproduction continues within the body. And the viruses brewed while the
anti-viral medicines are still present in a patient's system can be
especially lethal, as they are selected to carry mutations that render them
resistant to the original drug. Even in the United States, where an excellent
health care network monitors most drug regimens, about ten percent of
patients already harbor HIV strains resistant to AZT, the most common
anti-HIV drug. And if such potent drugs are dumped unsupervised on
Africa--where health care networks cannot afford to be as vigilant--then a
virulent, drug-resistant strain of HIV may emerge very quickly and could even
boomerang back to the West.
ortunately, there is an alternative to the solution hyped last week in
Durban. Since the safety of anti-HIV drugs depends on a country's health care
infrastructure, pharmaceutical companies could pay to develop in Africa some
of the infrastructure necessary to make sure their anti-HIV drugs are taken
properly.
Why would drug companies do something so altruistic? Because it's not
altruistic at all. After all, drug companies can only squeeze profits out of
Africa by selling Africans their anti-HIV drugs over a long period of time.
Right now, with about 22 million Africans infected with HIV, the demand for
anti-viral drugs seems inexhaustible. But, if a viral strain immune to a
company's drug emerged, the drugmakers would no longer have medicine Africans
wanted to buy. Even worse, the resistant virus might spread into more
profitable Western markets. Only by making an investment in health care
infrastructure--and thus preventing drug-resistant strains of HIV from coming
to life--can a pharmaceutical company ensure that its cash-cow drug isn't
rapidly made worthless by new mutations.
Glaxo Wellcome, at least, seems to understand this. In May, the company
announced it would enter an unusual collaboration with unaids to make sure
its discounted anti-HIV drugs would be sold only in selected areas--places
that "address[ed] the health care infrastructure and drug distribution
aspects" and where there was "access to safe and effective ongoing treatment"
for HIV. Glaxo also agreed to foot some of the bill for building these
infrastructures through direct training and technical support of aids
advocacy groups.
No one can be sure the Glaxo-UNAIDS scheme will work, because nothing like it
has ever really been tried. There isn't much precedent for such public and
private collaborations actually creating safe environments for selling
discounted drugs. But, then again, there isn't much precedent for a
recalcitrant virus infecting whole swaths of an entire continent. HIV is so
deadly because it is enormously resourceful, crafty, and even creative. To
defeat it, we will have to be, as well.
SIDDHARTHA MUKHERJEE is a resident in internal medicine at Massachusetts
General Hospital and a clinical fellow at Harvard Medical School.
We should therefore claim, in the name of tolerance, the right not to
tolerate the intolerant.
Karl Popper 1902-1994
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