The Deadly cost of business as usual

Elton Wong

“I have always recognized that the object of business is to make money in an honorable manner. I have endeavored to remember that the object of life is to do good.”

—Peter Cooper
Cooper Union
for the Advancement
of Science and Art

“Nothing is illegal if a hundred businessmen decide to do it.”

—Andrew Young
Professor of Economics

The casual observer might conclude that science is winning the war against AIDS. In the United States, new drugs including protease inhibitors and anti-reverse transcriptase medications have proven effective in controlling symptoms in patients. For $10,000 to $15,000 a year, the wealthy can turn what was once a deadly disease into something more like a chronic illness. This is certainly a change from the early days, when a diagnosis of HIV was the equivalent of a quick death sentence. Unfortunately, the medical breakthroughs in the Western world have not translated into benefits for the average AIDS patient, most of whom live in developing nations. There are several reasons for this. For one, many third-world governments are reluctant to even admit that AIDS is a problem. The president of South Africa, for instance, has not even encouraged the most modest AIDS prevention or education measures, because he believes, contrary to every bit of evidence, that the HIV virus is not the cause of AIDS. Even where there is a desire to deal with AIDS as a public health issue, the poorest nations lack the infrastructure to mount even educational campaigns, let alone prevention programs or treatment. Finally, nations are prevented from creating effective AIDS programs because of the high cost of drugs. The so-called “triple cocktail” of AIDS drugs can control the virus, but is too expensive for poor governments to afford.All is not lost for poor nations, however. Over the past few years Brazil has built a well-run network of AIDS clinics, even though the country’s public health foundation is shaky at best. The success of Brazil’s aggressive campaign against AIDS has shown results.In 1994, the World Bank estimated that by 2000 Brazil would have 1.2 million HIV-positive people. When 2000 arrived, Brazil had half that many. The incidence of new cases has stabilized, and the death rate from AIDS has been cut by about 50 percent.Brazil’s success story is a source of controversy, however. Brazil supplies the triple-cocktail drugs to all its AIDS patients, and it can only afford to do this by manufacturing generic versions of AIDS drugs in national labs. This tactic reduces the cost of the drugs by more than 79 percent, but has U.S. drug companies in an uproar over intellectual property laws.For another example, Thailand’s populace suffers greatly from AIDS, but Thailand’s government did not start producing anti-retroviral drugs until last year due to pressure from American drug companies and Washington. One such company, Bristol, even bullied the supplier of drug raw materials from selling to Thailand. Bristol and Glaxo are two companies that have been able to maintain a legal international monopoly on their drugs due to a controversial “safety monitoring” law, passed in 1993 due to American urging, that forces all generic competitors to wait five or six years before producing “knockoff” drugs. Laws like this are promulgated for business interests, not safety ones. The actions of these drug companies are particularly worthy of criticism because neither Bristol nor Glaxo invented the drugs they have the rights to. Glaxo’s AIDS drug 3TC was discovered by a Canadian company, and Bristol’s d4T was first synthesized by the Michigan Cancer foundation in 1966, using public funds. The use of this drug for AIDS was discovered at Yale University. In both cases, the companies bought the rights for the drugs at low prices. This was originally done for reasons of public interest, but this hasn’t stopped the companies from making lots of money. In the United States, Bristol sells Zerit for $4.50 for 40ml, yet international labs can sell the same for 30 cents.Pricing notwithstanding, the drug companies still lobby Washington to impose penalties on nations that manufacture knockoff drugs to save the lives of their citizens. Trade officials in the United States have placed many countries on the Special 301 watch list, which is one step above trade sanctions. Just being on the list is enough to discourage foreign investment in any given country. As a result, proponents of AIDS programs in poor nations must fight domestic as well as international pressures. In 1997, South Africa, which does respect international patents, passed laws that would allow compulsory licensing of certain essential medicines, including AIDS drugs. Thus, South African companies were allowed to manufacture the drugs in spite of the patents. Although the Clinton administration admitted that this action was legal under World Trade Organization law, it still pressured the South African government to repeal those laws to the point of withholding aid. Compulsory licensing allows a nation to ignore patent laws under special circumstances. The United States government uses this procedure in cases far less dire than the AIDS epidemic: tow trucks, stainless-steel wheels and corn seeds have been recently licensed this way.Obviously, no one wants to see the drug companies crippled. Like all other commercial enterprises, pharmaceutical corporations have the right to sell a product and make a profit. However, there is a difference between protecting one’s interests and profiteering. This is especially true in the case of AIDS drugs that can and do make the difference between life and death. Drug companies make virtually all their profit selling their products in America and the West, where people can afford them. It is unnecessary for the companies to pay Washington to bully poor nations who are merely trying to contain the AIDS explosion; sales to poor nations are not a real source of revenue in the first place.The Clinton administration eventually curtailed the influence of drug companies on trade policy after public outcry. We should now keep an eye on the Bush administration, to make sure that corporate interests will not be furthered to the detriment of human well-being. The licensing of AIDS drugs in poor countries will not make the AIDS problem disappear, but it is a step that opens a great many possibilities.Elton Wong is a senior in genetics and philosophy from Ames.