Article 102.qxp

Millions for Viagra,Pennies for Diseases of the Poor Almost three times as many people, most of them people who are vulnerable to malaria but too poor to in tropical countries of the Third World, die of preventable, curable diseases as die of AIDS.
Malaria, tuberculosis, acute lower-respiratory infec- Western interest in tropical diseases was historical- tions—in 1998, these claimed 6.1 million lives.
ly linked to colonization and war, specifically the People died because the drugs to treat those illness- desire to protect settlers and soldiers. Yellow fever es are nonexistent or are no longer effective. They became a target of biomedical research only after it died because it doesn’t pay to keep them alive.
began interfering with European attempts to controlparts of Africa. “So obvious was this deterrence … Only 1 percent of all new medicines brought to that it was celebrated in song and verse by people market by multinational pharmaceutical companies from Sudan to Senegal,” Laurie Garrett recounts in between 1975 and 1997 were designed specifically her extraordinary book The Coming Plague. “Well to treat tropical diseases plaguing the Third World.
into the 1980s schoolchildren in Ibo areas of In numbers, that means thirteen out of 1,223 med- Nigeria still sang the praises of mosquitoes and the ications. Only four of those thirteen resulted from diseases they gave to French and British colonial- research by the industry that was designed specifi- cally to combat tropical ailments. The others,according to a study by the French group Doctors US military researchers have discovered virtu- Without Borders, were either updated versions of ally all important malaria drugs. Chloroquine was existing drugs, products of military research, acci- synthesized in 1941 after quinine, until then the pri- dental discoveries made during veterinary research mary drug to treat the disease, became scarce fol- or, in one case, a medical breakthrough in China.
lowing Japan’s occupation of Indonesia. The dis-covery of Mefloquine, the next advance, came Certainly, the majority of the other 1,210 new about during the Vietnam War, in which malaria was drugs help relieve suffering and prevent premature second only to combat wounds in sending US death, but some of the hottest preparations, the ones troops to the hospital. With the end of a ground- that, as the New York Times put it, drug companies based US military strategy came the end of innova- “can’t seem to roll out last enough,” have absolute- ly nothing to do with matters of life and death. Theyare what have come to be called lifestyle drugs— T h e P h a r m a c e u t i c a l R e s e a r c h a n d remedies that may one day free the world from the Manufacturers of America (PhRMA) claimed in scourge of toenail fungus, obesity, baldness, face newspaper ads early this year that its goal is to “set wrinkles and impotence. The market for each drug every last disease on the path to extinction.” Jeff is worth billions of dollars a year and is one of the Trewhitt, a PhRMA spokesman, says US drug com- fastest-growing product lines in the industry.
panies will spend $24 billion on research this yearand that a number of firms are looking for cures for The drug industry’s calculus in apportioning its tropical diseases. Some companies also provide resources is coldblooded, but there’s no disputing existing drugs free to poor countries, he says. “Our that one old, fat, bald, fungus-ridden rich man who members are involved. There’s not an absolute can’t get it up counts for more than half a billion “Millions for Viagra, Pennies for Diseases of the Poor,” by Ken Silverstein from The Nation 7/19/99. Copyright by The Nation.
Reprinted by permission. 2 Millions for Viagra, Pennies for Diseases of the Poor
The void is certainly at hand. Neither PhRMA diseases,” says a retired drug company executive, nor individual firms will reveal how much money who wishes to remain anonymous. “Instead, it’s the companies spend on any given disease—that’s going to stockholders.” Also to promotion: In 1998, proprietary information, they say—but on malaria the industry unbuckled $10.8 billion on advertising.
alone, a recent survey of the twenty-four biggest And to politics: In 1997, American drug companies drug companies found that not a single one main- spent $74.8 million to lobby the federal govern- tains an in-house research program, and only two ment, more than any other industry last year they expressed even minimal interest in primary research spent nearly $12 million on campaign contributions.
on the disease. “The pipeline of available drugs isalmost empty,” says Dyann Wirth of the Harvard Just forty-five years ago, the discovery of new drugs School of Public Health, who conducted the study.
and pesticides led the World Health Organization “It takes five to ten years to develop a new drug, so (WHO) to predict that malaria would soon be erad- we could soon face [a strain of] malaria resistant to icated. By 1959, Garrett writes in The Coming every drug in the world.” A 1996 study presented in Plague, the Harvard School of Public Health was so Cahiers Santé, a French scientific journal, found that of certain that the disease was passé that its curriculum forty-one important medicines used to treat major didn’t offer a single course on the subject.
tropical diseases, none were discovered in thenineties and all but six were discovered before 1985.
Resistance to existing medicines—along with cutbacks in healthcare budgets, civil war and the Contributing to this trend is the wave of merg- breakdown of the state—has led to a revival of ers that has swept the industry over the past decade.
malaria in Africa, Latin America, Southeast Asia Merck alone now controls almost 10 percent of the and, most recently, Armenia and Tajikistan. The world market. “The bigger they grow, the more they WHO describes the disease as a leading cause of decide that their research should be focused on the global suffering and says that by “undermining the most profitable diseases and conditions,” one indus- health and capacity to work of hundreds of millions try watcher says. “The only thing the companies of people, it is closely linked to poverty and con- think about on a daily basis is the price of their tributes significantly to stunting social and econom- stocks; and announcing that you’ve discovered a drug [for a tropical disease] won’t do much for yourshare price.” Total global expenditures for malaria research in 1993, including government programs, came to That comment came from a public health advo- $84 million. That’s paltry when you consider that cate, but it’s essentially seconded by industry. “A one B-2 bomber costs $2 billion, the equivalent of corporation with stockholders can’t stoke up a labo- what, at current levels, will be spent on all malaria ratory that will focus on Third World diseases, research over twenty years. In that period, some 40 because it will go broke,” says Roy Vagelos, the for- million Africans alone will die from the disease. In mer head of Merck. “That’s a social problem, and the United States, the Pentagon budgets $9 million industry shouldn’t be expected to solve it.” per year for malaria programs, about one-fifth theamount it set aside this year to supply the troops Drug companies, however, are hardly strug- with Viagra. For the drug companies, the meager gling to beat back the wolves of bankruptcy. The purchasing power of malaria’s victims leaves the pharmaceutical sector racks up the largest legal disease off the radar screen. As Neil Sweig, an profits of any industry, and it is expected to grow by industry analyst at Southeast Research Partners, an average of 16 to 18 percent over the next four puts it wearily, “It’s not worth the effort or the while years, about three times more than the average for of the large pharmaceutical companies to get the Fortune 500. Profits are especially high in the involved in enormously expensive research to con- United States, which alone among First World nations does not control drug prices. As a result,prices here are about twice as high as they are in the The same companies that are indifferent to European Union and nearly four times higher than malaria are enormously troubled by the plight of dysfunctional First World pets. John Keeling, aspokesman for the Washington, DC-based Animal “It’s obvious that some of the industry’s sur- Health Institute, says the “companion animal” drug plus profits could be going into research for tropical market is exploding, with US sales for 1998 esti- Millions for Viagra, Pennies for Diseases of the Poor 3
mated at about $1 billion. On January 5, the FDA Baldness. The top two drugs in the Field, approved the use of Clomicalm, produced by Merck’s Propecia and Pharmacia & Upjohn’s Novartis, to treat dogs that suffer from separation Rogaine (the latter sold over the counter), had com- anxiety (warning signs: barking or whining, “exces- bined sales of about $180 million in 1998. “Some sive greeting” and chewing on furniture). “At Last, lifestyle drugs are used for relatively serious prob- lems, but even in the best cases we’re talking about Worldwide,” reads the company’s press release very different products from penicillin,” says the announcing the drug’s rollout. “I can’t emphasize retired drug company executive. “In cases like bald- enough how dogs are suffering and that their behav- ness therapy, we’re not even talking about health- ior is not tolerable to owners,” says Guy Tebbitt, vice president for research and development forNovartis Animal Health.
Toenail fungus. With the slogan “Let your feet get naked!” as its battle cry, pharmaceutical giant Also on January 5 the FDA gave the thumbs up Novartis recently unveiled a lavish advertising cam- to Pfizer’s Anipryl, the first drug approved for dog- paign for Lamisil, a drug that promises relief for gie Alzheimer’s. Pfizer sells a canine pain reliever sufferers of this unsightly malady. It’s a hot one, the and arthritis treatment as well, and late last year it war against fungus, pitting Lamisil against Janssen announced an R&D program for medications that Pharmaceuticals Sporanox and Pfizers Diflucan for help pets with anxiety and dementia.
shares in a market estimated to be worth hundredsof millions of dollars a year.
Another big player in the companion-animal field is Heska, a biotechnology firm based in Face wrinkles. Allergan earned $90 million in Colorado that strives to increase the “quality of life” 1997 from sales of its “miracle” drug Botox.
for cats and dogs. Its products include medicines for Injected between the eyebrows at a cost of about allergies and anxiety, as well as an antibiotic that $1,000 for three annual treatments, Botox makes fights periodontal disease, The company’s Web site crows feet and wrinkles disappear. “Every 7½ sec- features a “spokesdog” named Perio Pooch and, like onds someone is turning 50,” a wrinkle expert told old “shock” movies from high school driver’s-ed the Dallas Morning News in an article about Botox classes, a photograph of a diseased doggie mouth to last year. “You’re looking at this vast population demonstrate what can happen if teeth and gums are not treated carefully. No one wants pets to be inpain, and Heska also makes drugs for animal cancer, Meanwhile, acute lower respiratory infections but it is a measure of priorities that US companies go untreated, claiming about 3.5 million victims per and their subsidiaries spend almost nothing on trop- year, overwhelmingly children in poor nations.
ical diseases while, according to an industry source, Such infections are third on the chart of the biggest they spend about half a billion dollars for R&D on killers in the world; the number of lives they take is almost half the total reaped by the number-onekiller, heart disease, which usually strikes the elder- Although “companion animal” treatments are an ly. “The development of new antibiotics,” wrote extreme case—that half-billion-dollar figure covers drug company researcher A. J. Slater in a 1989 “food animals” as well, and most veterinary drugs paper published in the Royal Society of Tropical emerge from research on human medications—con- Medicine and Hygiene’s Transactions, “is very sider a few examples from the brave new world of costly and their provision to Third World countries human lifestyle drugs. Here, the pharmaceutical alone can never be financially rewarding.” In some cases, older medications thought to be Impotence. Pfizer invested vast sums to find a unnecessary in the First World and commercially cure for what Bob Dole and other industry unviable in the Third have simply been pulled from spokesman delicately refer to as “erectile dysfunc- the market. This created a crisis recently when TB tion.” The company hit the jackpot with Viagra, re-emerged with a vengeance in US inner cities, which racked up more than $1 billion in sales in its since not a single company was still manufacturing first year on the market. Two other companies, Streptomycin after mid-1991. The FDA set up a task Schering-Plough and Abbott Laboratories, are force to deal with the situation, but it was two years already rushing out competing drugs.
before it prodded Pfizer back into the field.
4 Millions for Viagra, Pennies for Diseases of the Poor
often undermines healthcare needs in developing announced that it would manufacture Ornidyl, thefirst new medicine in forty years that was effective In one case where a drug company put Third in treating African sleeping sickness. Despite the World health before profit—Merck’s manufacture benign sounding name, the disease leads to coma of Ivermectin—governmental inertia nearly scuttled and death, and kills about 40,000 people a year.
the good deed. It was the early eighties, and a Unlike earlier remedies for sleeping sickness, Pakistani researcher at Merck discovered that the Ornidyl had few side effects. In field trials, it saved drug, until then used only in veterinary medicine, the lives of more than 600 patients, most of whom performed miracles in combating river blindness were near death. Yet Ornidyl was pulled from pro- disease. With one dose per year of Ivermectin, peo- duction; apparently company bean-counters deter- ple were fully protected from river blindness, which mined that saving lives offered no return.
is carried by flies and, at the time, threatened hun-dreds of millions of people in West Africa.
Because AIDS also plagues the First World, it is the one disease ravaging Third World countries Merck soon found that it would be impossible that is the object of substantial drug company to market Ivermectin profitably, so in an unprece- research. In many African countries, AIDS has dented action the company decided to provide it wiped out a half-century of gains in child survival free of charge to the WHO. (Vagelos, then chairman rates. In Botswana—a country that is not at war and of Merck, said the company was worried about tak- has a relatively stable society—life expectancy rates ing the step, “as we feared it would discourage com- fell by twenty years over a period of just five. In panies from doing research relevant to the Third South Africa, the Health Ministry recently issued a World, since they might be expected to follow report saying that 1,500 of the country’s people are suit.”) Even then, the program nearly failed. The infected with HIV every day and predicting that the WHO claimed it didn’t have the money needed to annual deathrate will climb to 500,000 within the cover distribution costs, and Vagelos was unable to win financial support from the ReaganAdministration. A decade after Ivermectin’s discov- Yet available treatments and research initia- ery only 3 million of 120 million people at risk of tives offer little hope for poor people. A year’s sup- river blindness had received the drug. During the ply of the highly recommended multi-drug cocktail past few years, the WHO, the World Bank and phi- of three AIDS medicines costs about $15,000 a year.
lanthropists have finally put up the money for the That’s exorbitant in any part of the world, but pro- program, and it now appears that river blindness hibitive in countries like Uganda, where per capita will become the second disease, after smallpox, to income stands at $330. Moreover, different viral “families” of AIDS, with distinct immunologicalproperties, appear in different parts of the world.
Given the industry’s profitability, it’s clear that the About 85 percent of people with HIV live in the companies could do far more. Its equally clear that Third World, but industry research to develop an they won’t unless they are forced to. The success of AIDS vaccine focuses only on the First World.
ACT UP* in pushing drug companies to respond to “Without research dedicated to the specific viral the AIDS crisis in America is emblematic of how strains that are prevalent in developing countries, crucial but also how difficult it is to get the industry vaccines for those countries will be very slow in to budge. In late 1997, a coalition of public health coming,” says Dr. Amir Attaran, an international organizations approached a group of major drug expert who directs the Washington-based Malaria companies, including Glaxo-Wellcome and Roche, and asked them to fund a project that would dedi-cate itself to developing new treatments for major All the blame for the neglect of tropical dis- tropical diseases. Although the companies would eases can’t be laid at the feet of industry. Many have been required to put up no more than $2 mil- Third World governments invest little in healthcare, lion a year, they walked away from the table. Since and First World countries have slashed both foreign there’s no organized pressure—either from the aid and domestic research programs. Meanwhile, grassroots or from governments—they haven’t the US government aggressively champions the come back. “There [were] a number of problems at interests of the drug industry abroad, a stance that the business level,” Harvey Bale, director of the Millions for Viagra, Pennies for Diseases of the Poor 5
for the companies,” says Attaran. “They didn’t Pharmaceutical Manufacturers’ Association, told skimp on the plaque; it’s a nice one. But either the Science magazine. “The cost of the project is high companies should have paid for part of the govern- ment’s research, or they should have been requiredto sell the vaccine at a much lower price.” While the industry’s political clout currently insures against any radical government action, even At the beginning of this year, Doctors Without minor reforms could go a long way. The retired drug Borders unveiled a campaign calling for increased company executive points to public hospitals, access to drugs needed in Third World countries.
which historically were guaranteed relatively high The group is exploring ideas ranging from tax profit margins but were obligated to provide free breaks for smaller firms engaged in research in the care to the poor in return. There’s also the example field, to creative use of international trade agree- of phone companies, which charge businesses high- ments, to increased donations of drugs from the er rates in order to subsidize universal service.
multinational companies. Dr. Bernard Pécoul, an “Society has tolerated high profit levels up until organizer of the campaign, says that different now, but society has the right to expect something approaches are required for different diseases. In the back,” he says. “Right now, it’s not getting it.” case of those plaguing only the SouthernHemisphere—sleeping sickness, for example— The US government already lavishly subsidizes market mechanisms won’t work because there sim- industry research and allows companies to market ply is no market to speak of. Hence, he suggests that discoveries made by the National Institute of Health if multinational firms are not willing to manufacture and other federal agencies. “All the government a given drug, they transfer the relevant technology needs to do is start attaching some strings,” says the Malaria Project’s Attaran. “If a company wants tomarket another billion-dollar blockbuster, fine, but Drugs already exist for diseases that ravage the in exchange it will have to push through a new North as well as the South—AIDS and TB, for malaria drug. It will cost them some money, but it’s example—but they are often too expensive for peo- ple in the Third World. For twenty-five years, theWHO has used funding from member governments Another type of “string” would be a “reason- to purchase and distribute vaccines to poor coun- able pricing” provision for drugs developed at fed- tries; Pécoul proposes a similar model for drugs for eral laboratories. By way of explanation, Attaran tropical diseases. Another solution he points to: In recounted that the vaccine for hepatitis A was large- the event of a major health emergency, state or pri- ly developed by researchers at the Walter Reed vate producers in the South would be allowed to Army Institute. At the end of the day, the govern- produce generic versions of needed medications in ment gave the marketing rights to SmithKline exchange for a small royalty paid to the multina- Beecham and Merck. The current market for the tional license holder. “If we can’t change the mar- vaccine, which sells for about $60 per person, is kets, we have to humanize them,” Pécoul says.
$300 million a year. The only thing Walter Reed’s “Drugs save lives. They can’t be treated as normal researchers got in exchange for their efforts was a plaque that hangs in their offices. “I’ll say one thing


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