April 30, 2002
Doesn't somebody have to pay for all this? ...
The World Health Organization has just made two major changes in its official policies. First, it has placed what we've come to call the "AIDS cocktail," the use of three drugs in combination, as a standard for medical treatment for every country, no matter how poor. Simultaneously, it has placed 10 approved drugs on its list of "essential medicines."
For some, this move appears to be glacial in nature; For others, it's a resounding defeat of the misguided notion that HIV is not a problem.
Here in the United States, our sense is that we've found an effective medical solution, at least for the time being. Our collective impression is that people on triple-drug therapy are able to lead fruitful lives. For the almost 2 million people living with HIV across North America and Europe, that's very good news.
And what's the bad news? This well-tended group amounts to only 4% of the people living with HIV worldwide.
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Nearly 30 million HIV-positive people live in sub-Saharan Africa. And how many of them receive the triple drug combo? Would you believe they number in the tens of thousands? That's right. 28 million people infected. Less than one million being treated.
I frequently offer the premise that once we actually have a proven medical technology, it's inhumane to deny it to anyone. While this seems self-evident, it causes me great concern when it actually comes to implementation.
The development of effective HIV drug therapies was funded by governments, private individuals, foundations and pharmaceutical companies. Ultimately, we all depend on the drug companies to create, manufacture, distribute and guarantee the quality of the drugs themselves.
In our present model, the pharmaceutical firms are publicly-held corporations. As such, they are required by law to return a profit to their investors. But a proposition which requires coming up with new drugs of any sort is both expensive and fraught with risk. Many options must be researched; few are rewarding.
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And here's where I start to worry. Whether you believe that the drug companies make way too much money, or are compromised by their profitable nature, they are motivated to create new medical technologies. And they are willing to pay for the research.
We don't like paying the price, but here in the United States we do expect our drugs to get better every year. And in some equivalent to the electronics industry, we also expect them to get smaller, faster and cheaper.
The problem is that the economic model for medical technology only works in the world's richest economies. Where does the model account for how these drugs will ultimately get to every human who needs them?
Taking the electronics example one step further, cutting-edge chips have a honeymoon period, where the bulk of the profit for research and development can be recovered. Then there's a period where other companies jump in and drive the price down. What if the original FDA approval depended not only on the safety of the drug, but also a cross-approval from the Department of Commerce, guaranteeing there was a worldwide plan to a reasonable timeframe distribute these drugs to everyone?
Well, that's just one idea. Let's all start thinking about how to solve this problem in general. After all, what makes the biggest difference in accomplishing anything is simply having the intention to do so.
I'm Moira Gunn. This is Five Minutes.
