In the law of the market, businesses charge whatever they think the market will bear – except in medicine, where costs come weighed with moral dilemmas. Multi-billion dollar pharmaceutical companies are roundly, fundamentally, and universally scorned when they charge developing countries western-nation prices for their miracle pills. Now, some countries are telling drug companies they won’t pay.

Over the past year, Thailand and Brazil began overriding the patents for a costly new AIDS medicine from Merck. Bill Clinton backed both countries for taking advantage of a “national emergency” clause under WTO rules. Clinton’s charitable foundation heaped onto big pharma’s pain by negotiating steep discounts on antiretroviral drugs from generic manufacturers. “No company will live or die because of high price premiums for AIDS drugs in middle-income countries, but patients may,” explained the former US president. The drug companies defended their pricing.

In recent years, pharmaceutical companies have offered discounts on vital medicines to middle-income countries, while charging the poorest countries only production costs. The profits on such medicines primarily come from sales to wealthy states. Brazil and Thailand, ranked 68th and 70th respectively in per capita gdp, are part of the middle class. Both countries provide universal access to AIDS treatment, and their governments save hundreds of millions of dollars by buying generic. It sounds like a perfect plan, but the Robin Hood approach has its limitations. Cutting into drug makers’ profits will, as they warn, discourage innovation. Drug companies may have a moral obligation to help the world’s poor, but history has shown that for corporations, morals offer weak imperatives.

Trisha Shears

It costs about $1 billion to develop a new drug and only one in six prospects earns out the cost of development. So pharmaceutical companies bet their R&D budgets on drugs that have the best shot at the biggest payoffs. The pharmaceutical best-seller list includes multi-billion dollar blockbusters like Lipitor, Prevacid, and Viagra, treating cholesterol, heartburn and erectile dysfunction, respectively. They’re the disorders of the wealthy, aging and overfed West.

Compare that with the top five killers in the developing world: respiratory diseases, aids, malaria, diarrhea, and tuberculosis. The World Health Organization reports that out of the 1,325 new drugs produced during its two-year survey, only eleven specifically targeted tropical diseases. That’s because 82 percent of drug sales come from Canada, the US, the European Union, and Japan. Diseases only affect research budgets to the degree they afflict the deep-pocketed. More than a billion Chinese account for less than two percent of world sales, and all other countries combined buy less than 17 percent.

A more glaring sign of market failure is the scarcity of new vaccines. Immunization research is as expensive as drug research, but makes lousier business sense to pursue. Effective vaccines eliminate the customer base in a morally good, financially bad kind of way. So thousands of new drug treatments are introduced each year compared to a trickle of new or improved vaccines. Three of the world’s great killers – aids, malaria, and tuberculosis – could be eliminated once and forever with viable vaccines.

Corporate responsibility and activist pressure have won important gains. Bristol-Myers Squibb voluntarily licensed an antiretroviral royalty-free to generic manufacturers for India and Africa. The mere idea of such royalty-free drugs owes to the activists who fought for them. But these and the savings in Brazil and Thailand will be short-lived victories if the pipeline for new medicines dries up. Why would a drug maker pursue AIDS medicine if there’s more money in erectile dysfunction? Activists’ gains may save lives now, but will ensure fewer AIDS drugs in the future.

Medicine is, unlike other goods, an issue of ethics and morality. With the power to save lives, drug makers bear a burden of responsibility that other manufacturers don’t share. But it’s futile to keep wishing that big pharma will take up more of that responsibility. The world needs to find and build new engines of innovation. We can’t keep letting the laissez-faire economy dictate which medicines the planet’s poorest nations receive.

There are encouraging signs. Non-profits like the International AIDS Vaccine Initiative, the Wellcome Trust, and the Global Fund to Fight aids, Tuberculosis and Malaria, contribute substantially to the development of new medicines. As the corporate well dries up, attention needs to shift from pressuring corporations to encouraging efforts like these so that more people in the developing world don’t end up paying with their lives.

_Dee Hon

COMMENTS:

Nationalize drug companies – if we can't expect drug companies for profit to be moral we should demand it from our governments. Medication for profit is in of itself immoral.
Joanna

i think ไม่รุ้ดิ
gee

There are some industries which should be above making money. One of them is the medical industry. Complete socialized medical treatment for EVERYONE!
Mike Smith

Too much anger, not enough commitment from the author.
Robert K

Joanna said it perfectly. Around 60% of our national budget is aimed at defense read: war. We need to insure all Americans and nationalize healthcare fully.
Bret

The vaccines given to babies lowers their immune systems for life, or produces mental retardation and autism. The mass experimentation of untested vaccines on our own military is sending troops home with all kinds of strange ailments. While the food supply is being systematically destroyed by pesticides, demineralized soil and genetic modification, doctors – who have lost all sense of ethics – are prescribing drugs to mask the symptoms of no nutrition. i say leave the poor people the hell alone – as long as they are safe from medicine they'll be a lot healthier than the stupid fools who think medical insurance is a good thing to have.
lucy brown

True, it may cost a billion dollars to develop a new drug, but let's not forget that a good deal of that money is in fact spent by governments for funded research and donations from individuals. In a lot of cases, you ask researchers (yes, the guy with the lab coat, not the shark with the suit) about what kind of work they see themselves doing and most of them are candid in their altruistic ambitions, favoring a noble cause over limp penises in most cases. It's convincing the overfed, rich shareholder that a mostly tax-refunded or government subsidized lab belonging to a corporation will sometimes have to work for the greater civic good... which isn't an easy sell after years of free rides and kickbacks.
Alex

I think we need to look more deeply. Wellness is not about the availability of pharmaceuticals. We need to question whether many or most drugs are really helping us. My own experience, recovering from critical illness six years ago, is that often they are making us sicker. The modern trance is deepest when we are facing the terror of critical illness for ourselves or for someone we love. Waking up and honoring our real choices is imperative. Most of these choices can't be bought, sold or advertised.
Peggy

Right, because drug development is cheap and easy.
Mike

Yeah, the problem with having a national drugs company is that many of the resources needed are rare and only found in certain parts of the world. Also, any new competition could easily be killed off by the existing companies if the politicians aren't just bribed into not doing it anyway.
james mcm

SO what does someone like Lucy brown do when she breaks a leg, needs stitches, has an organ fail, has a stroke, gets pregnant...You can say vaccine testing is risky and some side effects of vaccine's are negative and in what percentage, but when your child gets mumps and you bleed to death...well, let's not make broad generalizations without supportive facts, numbers.
Medical Insurance

Great article. Something I find discouraging is all the factions of non-profits. I understand have goals to find cures for X,Y,Z but it puts a strain on people to choose who devote time, money and energy into. We can't help all the factions but if there was one large mega group we could support I could see more results. Another eye-opening article!
elly

Right on, Lucy!
Peggy

While we all could benefit from healthier lifestyles which would leave us less dependent on drugs to fend off disease, vaccinations are not a bad thing. Note how they've eradicated that killer Polio. As for AIDS, even independent scientists not beholden to big pharmaceuticals admit that the unusual speed with which the virus mutates makes it very difficult, at best, to come up with an effective vaccine. So let's not blame the drug companies solely for the lack of one.
S. Wolf

The first and most important step to solving this problem would be to have the support from the Doctors treating these diseases. Effective diagnosing would yield more pressure to develop these vital vaccines. The entire field of medicine is devoted and designed to promote the health of the greater good...is it not?
K. Cawood

I had looked into this myself before I saw your article, and didn't find proof for some of the claims you make. According to a study in the medical journal The Lancet, in 2001 the top causes of death in low and middle income countries were: 1. Heart disease, 2. Stroke, 3. Lower respiratory infections, 4. HIV/AIDS, 5. Fetus/newborn perinatal conditions (Lopez, A. The Lancet, May 27, 2006; vol 367: pp 17471757). I couldn't find the top selling drugs for that year, but in the twelve months leading up to March 2007 the top five included Lipitor (heart disease), Seretide (lower respiratory infections), Plavix (stroke), and Norvasc (heart disease). http://www.imshealth.com/web/content/0,3148,64576068638727027026099881158535,00.html I agree wholeheartedly that companies are screwing poor countries and good in terms of prices, but I hope you're not just publishing your feelings about the irrelevance of drug companies, instead of looking into whether or not your feelings are just feelings.
Alex

please jam $1000 up your anus and we will remove it the next time you come in for you regular prostate exam.
pfizer

I just got a call from some 'charity' asking me to donate my hard earned money to some German drug company to pay for doses of an anti HIV drug for the developing world. Apparently the drug is a serum of some kind and has a short shelf life. Another fact is that the market for this drug is so tiny the drug company cannot profit from it. Here's the 'gotcha': a multibillion dollar drug company wants me to foot the bill, via donation, for testing their vaccine on unsuspecting poor people and their babies. If the market is so small for this drug why would they not just donate the drug and rely on their other products to subsidize the trial to an informed population. Apparently a bunch of doctors $$$fuckers in Canada are on board with this promoting it. My guess is they have money invested and Hypocrates is rolling over in his grave yet again. Stop using the developing world to test your 'thalidomide', and stop asking me to be complicit.
Pete

The #4 killer in the world is prescribed drugs.
kaspa

My thoughts exactly, Pete!
T. Fiedler

I thought I have not got the figures to hand, unfortunately, that most big drug companies had advertising budgets that were comfortably larger than their R & D budgets. A little redistribution would help keep R & D going if they reduced their prices.
Becky

I have no faith. I see ads for new pills (maybe Cymbalta?) and am disgusted. Billions spent, research suppressed? cheaper versions oppressed? Do I really need all they are feeding me. Maybe we should spend some of this wasted fortune on doctors and nurses. who are now even harder to trust. Wash your hands!
David

I agree with kaspa. The way these pharmaceutical monsters get away with it, is in the fine print. possible side effects...etc. they're all designed to keep you reliant on them while at the same time, slowly killing you.
Daniel

i like it
mclovin

Something not stressed here is that the drug companies are getting much of their research done on the cheap by going to university research departments and getting their drugs information for a mere pittance compared to doing their own research. These drug companies do not have expensive R&D these days.
Carol Jones

Well-written. Thank you.
C.E.

I work in the medical industry as an RN. Investigate the side effects of the medication before you take it, and look at alternative food/herb intake to correct the underlying problem, ie; we lack magnesium in our diet, and yes. Magnesium loss contributes to lots of problems with the cardiovascular system, like hypertension, cardiac arrythmias etc. A supplement of mag does wonders, ask your doctor about it. Be armed with the double blind studies. Go to pubmed and research it and print and take with you to doctor, he cant ignore it. We need to be an advocate for ourselves. Find someone knowledgeable about your condition and foods/herbs that will contribute to correct it. Research it before taking any meds. Some meds that are blood pressure meds, you can't stop them once you start them. Do you want to be chained to financial crisis/medication for the rest of your life or change your eating habits? The meds will kill you, believe me, I tell you the truth. Another thing, what about the FDA being paid by the big pharma. I can't believe pharma is dictating what meds we can have, and meds we can't have.
Nikki

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