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Healthy Skepticism Library item: 2013

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

Silverstein K.
Millions for Viagra, Pennies for the Poor
The Toronto Star 1999 Aug 13

Full text:

One old, fat, bald, fungus-ridden rich man who can’t get it up means more to the pharmaceutical industry than half a billion poor people vulnerable to malaria.

And almost three times as many people – most in tropical areas of the Third World – die of preventable, curable diseases as die of AIDS.

Malaria, tuberculosis, acute lower respiratory infections claimed 6.1 million lives in 1998. People died because the drugs to treat those illnesses are non-existent or are no longer effective. They died because it doesn’t pay to keep them alive.

Only 1 per cent of all new medicines brought to market by multinational pharmaceutical companies between 1975 and 1997 were designed specifically to treat tropical diseases plaguing the Third World. In numbers, that means 13 out of 1,223 medications.

Certainly, the majority of the other 1,210 new drugs help relieve suffering and prevent premature death, but some of the hottest preparations have nothing to do with matters of life and death. They are lifestyle drugs – remedies that may one day free the world from the scourge of toenail fungus, obesity, baldness, face wrinkles and impotence.

The market for such drugs is worth billions of dollars a year and is one of the fastest-growing product lines in the industry.

Western interest in tropical diseases was historically linked to colonization and war, specifically the desire to protect settlers and soldiers.

Yellow fever became a target of biomedical research only after it began interfering with European attempts to control parts of Africa. ‘‘So obvious was this deterrence . . . that it was celebrated in song and verse by people from Sudan to Senegal,’‘ Laurie Garrett recounts in her extraordinary book The Coming Plague. ‘‘Well into the 1980s schoolchildren in Ibo areas of Nigeria still sang the praises of mosquitoes and the diseases they gave to French and British colonialists.’‘

U.S. military researchers have discovered virtually all important malaria drugs. Chloroquine was synthesized in 1941 after quinine, until then the primary drug to treat the disease, became scarce following Japan’s occupation of Indonesia.

The discovery of Mefloquine, the next advance, came about during the Vietnam War, in which malaria was second only to combat wounds in sending U.S. troops to the hospital. With the end of a ground-based U.S. military strategy came the end of innovation in malaria medicine.

The Pharmaceutical Research and Manufacturers of America (PhRMA) claimed in U.S. newspaper ads early this year that its goal is to ‘‘set every last disease on the path to extinction.’‘ Spokesperson Jeff Trewhitt says U.S. drug companies will spend $24 billion on research this year and that many firms are looking for cures for tropical diseases. Some companies also provide existing drugs free to poor countries, he says.

The void is certainly at hand. Neither the pharmaceutical manufacturers association nor individual firms will reveal how much money the companies spend on any given disease – that’s proprietary information. But on malaria alone, a recent survey of the 24 biggest drug companies found that not a single one maintains an in-house research program, and only two expressed even minimal interest in primary research on the disease.

‘‘The pipeline of available drugs is almost empty,’‘ says Dyann Wirth of the Harvard School of Public Health, who conducted the study. ‘‘It takes five to 10 years to develop a new drug, so we could soon face (a strain of) malaria that’s resistant to every drug in the world.’‘

A 1996 study presented in Cahiers Sante, a French scientific journal, found that of 41 important medicines used to treat major tropical diseases, none was discovered in the ’90s and all but six were discovered before 1985.

‘The only thing (drug) companies think about is the price of their stocks’

Contributing to this trend is the wave of mergers that has swept the industry over the past decade. Merck alone now controls almost 10 per cent of the world market.

‘‘The bigger they grow, the more they decide that their research should be focused on the most profitable diseases and conditions,’‘ one industry watcher says. ‘‘The only thing the companies think about on a daily basis is the price of their stocks. And announcing that you’ve discovered a drug (for a tropical disease) won’t do much for your share price.’‘

That comment came from a public health advocate, but it’s essentially seconded by industry. ‘‘A corporation with stockholders can’t stoke up a laboratory that will focus on Third World diseases, because it will go broke, ‘’ says Roy Vagelos, the former head of Merck. ‘‘That’s a social problem and industry shouldn’t be expected to solve it.’‘

Drug companies, however, are hardly struggling to beat back the wolves of bankruptcy. The pharmaceutical sector racks up the largest legal profits of any industry and it is expected to grow by an average of 16 to 18 per cent over the next four years, about three times more than the average for the Fortune 500.

‘‘It’s obvious that some of the industry’s surplus profits could be going into research for tropical diseases,’‘ says a retired drug company executive, who wishes to remain anonymous. ‘‘Instead, it’s going to stockholders.’‘

And to promotion ($10.8 billion on advertising in 1998). And to politics. (American drug companies spent $74.8 million in 1997 to lobby the U.S.government. Last year they spent nearly $12 million on campaign contributions.)

Just 45 years ago, the discovery of new drugs and pesticides led the World Health Organization to predict that malaria would soon be eradicated. By 1959, Garrett writes in The Coming Plague, the Harvard School of Public Health was so certain that the disease was passe that its curriculum didn’t offer a single course on the subject.

Resistance to existing medicines – along with cutbacks in health care budgets, civil war and the breakdown of the state – has led to a revival of malaria in Africa, Latin America, Southeast Asia and, most recently, Armenia and Tajikistan. The World Health Organization describes the disease as a leading cause of global suffering.

For the drug companies, the meagre purchasing power of malaria’s victims leaves the disease off the radar screen.

Among the problems the pharmaceutical companies are scrambling to eradicate are:

Impotence. Pfizer invested vast sums to find a cure for what Bob Dole and othe rindustry spokespersons delicately refer to as ‘‘erectile dysfunction.’‘ The company hit the jackpot with Viagra, which racked up more than $1 billion in sales inits first year on the market. Two other companies, Schering- Plough and Abbott Laboratories, are rushing out competing drugs.

Baldness. The top two drugs in the field, Merck’s Propecia and Upjohn’s Rogaine had combined sales of about $180 million in 1998.

Toenail fungus. With the slogan ‘‘Let your feet get naked!’‘ as its battle cry, pharmaceutical giant Novartis recently unveiled a lavish advertising campaign for Lamisil, a drug that promises relief for suffers of this unsightly malady. The war against fungus involves a market estimated to be worth hundreds of millions of dollars a year.

Face wrinkles. Allergan earned $90 million in 1997 from sales of its ‘‘miracle’‘ drug Botox. Injected between the eyebrows at a cost of about $1, 000 for three annual treatments, Botox makes crow’s feet and wrinkles disappear. ‘‘Every 7 1/2 seconds someone is turning 50,’‘ a wrinkle expert told the Dallas Morning News in an article about Botox last year. ‘‘You’re looking at this vast population that doesn’t want frown lines.’‘

Meanwhile, acute lower respiratory infections go untreated, claiming about 3.5 million victims per year, overwhelmingly children in poor nations. Such infections are third on the chart of the biggest killers in the world; the number of lives they take is almost half the total reaped by the Number One killer, heart disease, which usually strikes the elderly.

In some cases, older medications thought to be unnecessary in the First World and commercially unviable in the Third have simply been pulled from themarket. This created a two-year crisis recently when TB re-emerged with a vengeance in U.S. inner cities, since not a single company was still manufacturing Streptomycin after mid-1991.

All the blame for the neglect of tropical diseases can’t be laid at the feet of industry. Many Third World governments invest little in health care, and First World countries have slashed both foreign aid and domestic research programs. Meanwhile, the U.S. government aggressively champions the interests of the drug industry abroad, a stance that often undermines health care needs in developing countries.

Given the industry’s profitability, it’s clear the companies could do far more. It’s equally clear that they won’t unless they are forced to.

While the industry’s political clout currently insures against any radical government action, even minor reforms could go a long way.

At the beginning of this year, Doctors Without Borders unveiled a campaign calling for increased access to drugs needed in Third World countries. It’s exploring ideas ranging from tax breaks for smaller firms engaged in research in the field, to creative use of international trade agreements, to increased donations of drugs from the multinational companies.

Campaign organizer Dr. Bernard Pecoul says different approaches are required for different diseases. In the case of those plaguing only the Southern Hemisphere- sleeping sickness, for example – market mechanisms won’t work because there simply is no market to speak of.

He suggests that if multinational firms are not willing to manufacture a given drug, they transfer the relevant technology to a Third World producer that is.

‘If we can’t change the markets, we have to humanize them’

Drugs already exist for diseases that ravage the North as well as the South – AIDS and TB, for example – but they are often too expensive for people in the Third World.

For 25 years, the World Health Organization has used funding from member governments to purchase and distribute vaccines to poor countries. Pecoul proposes a similar model for drugs to treat tropical diseases.

Another solution he points to: In the event of a major health emergency, state or private producers in the South would be allowed to produce generic versions of needed medications in exchange for a small royalty paid to the multinational license holder.

‘‘If we can’t change the markets, we have to humanize them,’‘ Pecoul says. ‘‘Drugs save lives. They can’t be treated as normal products.’‘


Dear colleagues,

I have read this article with great interest, but why is everybody so
naive? The pharmaceutical industry is one like every other business,
and it doesn’t make the slightest difference whether one
manufactures vacuum cleaners, margarine, guns, automobiles or
whatever. The goal is to make money and if one wants to make
money one needs capital, and that capital is provided by the
shareholders, who expect revenues. I have also shares in Shell and
Unilever, but that doesn’t make me an abject criminal.

If one looks at worldwide sales statistics it is obvious that between 60
and 70% of the revenues come from the USA, some 20% from
Europe, and a tiny bit from Africa and Asia. If the Americans want
to be robbed to get a few hairs on their head and their willy up that
is absolutely OK. Only very few Americans look beyond their
borders, but there are some shining examples of Americans who used their money for international
charity like George Soros (who was Greek) and the guy who saved
the UN budget by giving them one billion. Look how long it took to
convince Bill Gates that he should give a share of his gold mountain
away. It is not the moral duty of the private pharmaceutical industry
to make drugs for the third world – even though they themselves
sometimes pretend to do so. You cannot force them.

Some of the best new drugs were developed by government
institutions (zidovudine, taxol) or come from non-commercial
sources like the artemisia derivatives.

Remember the definition of capitalism: You have two cows, you sell
one and buy a bull. The socialist gives one of his cows away to his
neighbour. Who will in the end produce the milk?

Koedijklaan 1a, NL-1406KW Bussum, The Netherlands
Phone: +31-35-6923288. Fax: +31-35-6923290
E-mail: LO@EURONET.NL CompuServe: 71530,15


Leo Offerhaus’ analysis of the Pharmaceutical industry is quite accurate.
Clearly there is no profit motivation for sales in most developing
countries but then there is also no profit loss from cut price sales in
these countries as well. Parallel importing and compulsory licensing would
have no effect on the bottom line of these companies. The danger for them
is having consumers in developed countries say “How is it possible to
produce and sell drugs in poor countries at one tenth or twentieth of the
price I have to pay in the US?”

The key issue to understand is what motivates these companies and then
find ways to work within these frameworks. In some cases this may be
massive support for tropical disease programs such as the ivermectin, or
albendazole or achromycin donations. In other cases it may be guaranteeing
purchases of product such as Hepatitis B vaccine, in other situations it
may be setting price controls or establishing pricing regulations and in a
few extreme situations compulsory licensing may be necessary.

There are many areas where common interest exists between drug companies
and essential drug programs such as quality assurance, attacking
counterfeit drugs in the market, assisting in the conducting of clinical
trials etc and these are positive areas where cooperation is possible. It
is unrealistic to expect brand name companies to support generic promotion
programs, objective drug information projects or efforts to enforce the WHO
guidelines on drug promotion.

So my approach is to identify those areas where cooperation is possible and
to recognize that in some areas conflict is inevitable.

Richard Laing
Associate Professor of International Health
Boston University School of Public Health
715 Albany St, T4W, Boston MA 02118 USA
Tel 617 414-1444 Fax 617 638-4476


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