Healthy Skepticism Library item: 19906

Warning: This library includes all items relevant to health product marketing that we are aware of regardless of quality. Often we do not agree with all or part of the contents.

Publication type: news

Garrett A
Free drugs fro the poor give doctors a PR tonic
Observer 1998 Feb 18

Full text:

For million of sufferers in the developing world, elephantiasis means a swelling of limbs and genitals by up to three times their normal size. As well as the severe physical disability, they face ostracism, and many will never marry.

Last week, pharmaceuticals company SmithKline Beecham announced a huge programme, in conjunction with the World Health Organisation, aimed at eradicating this tropical disease over the next 20 years. The company will donate enough of its drug Albendazole to the WHO to treat up to a billion people in 70 countries. SmithKline estimates this will cost it between £300 million and £1 billion.

Such initiatives improve the image of the pharmaceutical industry, which has often been accused of doing little to help the developing world.

US company Merck is in the 10th year of a programme to fight river blindness: It has offered to supply its drug, Mectizan, free for as long as it is needed. And UK-based Glaxo Wellcome is starting to offer its anti-malaria treatment, Malarone, in Kenya.

However, the philanthropic image of such programmes has been tarnished by gifts of drugs that were inappropriate, or way past their expiry date. Appetite stimulants were sent to starving people in the Sudan, and women in Lithuania were temporarily blinded by free drugs that were wrongly identified.

This led the WHO to publish guidelines last May for donations: the drugs should be relevant, approved and solicited by the receiving country, and they should arrive a year before their expiry date.

But some questions whether donating drugs is the most effective way for pharmaceutical companies to help Anne-Marie Huby, UK director of Médecins Sans Frontières, says that while SmithKline Beecham’s commitment on elephantiasis is to be applauded, a much bigger issue is the availability of drugs to counter the world’s biggest killer diseases, TB, malaria and dysentry.

Many of the most effective drugs are still under patent and too expensive for public health authorities in developing countries, she says. “We think it healthier to discuss prices than to rely on charity”. MSF has already persuaded one company, Germany’s Bayer, to sell it five years’ supply of an antibiotic used against dysentery at less than 10 per cent of the market price.

Carolyn Green of Echo International Health Services, which buys medical supplies for other charities, makes a similar point: “If the drugs companies can get a return on their investment in the First World, why should they then not produce sufficient at cost for the Third World?”

Drug donations programmes are likely to be carefully selected by companies for their public relations value. Offering lower prices to poorer countries might not make such a good story.

The firms are also accused of devoting little of their research budgets to conditions, such as malaria, that affect those in the developing world. But Green says they are not intended to be humanitarian organisations. “Only 1 per cent of global pharmaceutical spend is in Africa, so if you look at it through the marketer’s eyes, they will not waste much of their research budget there”.

One of the most contentious issues is AIDS drugs. “The new triple combination therapies cost at least $10,000 a year, and have to be taken for life. Critics say they are out of the reach of all but the wealthiest people in the West, but there is little hope of any full-scale free donations of these drugs. Glaxo Wellcome, which produces two drugs used in such therapies, AZT and STC, is involved in a limited UN initiative to provide the drugs at discounted prices. But its spokesman, Martin Sutton, argues: “You have to take between 16 and 20 tablets a day. Experts say it wouldn’t work in the developing world without significant educational programmes”.

Even so, charities are more likely to spend their money on cheaper treatment for problems affecting more people.