Ben Goldacre

Saturday April 28, 2007

The Guardian

In the west we breathlessly report on new breakthroughs in science, but it’s easy to forget that ideas are bought, rented and sold, as surely as deckchairs. Last week the academic blogger Shelley Batts received threats of legal action from academic publisher Wiley, simply for using a diagram on her blog, in a discussion about a foolish news story, which was based on an academic article published in a Wiley journal.

But the big unreported intellectual property issue from science this week is in Thailand, where there are more than half a million people living with HIV, and 120,000 have Aids, requiring treatment. First-line Aids drugs are becoming ineffective, as the virus becomes resistant, and so people need the expensive new drugs like Kaletra, made by the US drug company Abbott.

Fighting HIV with drugs is an incredibly clever field. Some work by blocking the molecular machinery that produces virus DNA. Kaletra is a “protease inhibitor“, and it works by blocking the activity of an enzyme called protease which cleaves proteins into smaller chunks which can then be assembled into a functioning HIV virus.

Abbott has been charging $2,200 (Â£1,100) a year for Kaletra in Thailand, which is – by macabre coincidence – roughly the same as the gross income per capita. I am no economist, but it seems to me that if you charge people’s entire annual income for a drug like that, then your customers will die.

Don’t pharmaceutical companies need to charge high fees, to recoup their research costs, and develop new ideas? Yes, they do, so let’s be fair. And if we’re going to be really fair, we might also mention that they spend twice as much on administration and advertising as they do on research.

So in January the Thai government put their hands up and announced they were going to use Abbott’s idea, and make Abbott’s drug, only for the country’s poor, in their own factories, to save lives. Abbott has retaliated by completely withdrawing its new heat-stable version of Kaletra from the Thai market and withdrawing six other new drugs from the country for good measure. It has refused to bring its products back to the Thai market until the government promises not to use a “compulsory license” on its drug ideas. To some this might seem on a par with taking hostages (or making them say sorry “like they mean it”).

In fact, the Thai government has a good history of forcing the drug companies to release their wares at more realistic prices and, interestingly, it has broken no laws. The 2001 Doha declaration made it clear that governments should put public health before companies’ patent rights, and under the TRIPS agreement from the WTO, governments can sign up to respect a patent, with the caveat that they can make the drug themselves, or import a generic version, in a national emergency.

So the US, for example, announced its intention to import generic Ciprofloxacin following the anthrax panic, sidestepping the patent on that drug, in the name of practicality in a crisis. The US terrorist anthrax epidemic killed six people, which says a lot about how the definition of national emergency can shift depending on who is dying.

But the fact that we feel entitled to be outraged at Abbott is almost more interesting than the question of intellectual property: because for some reason, we expect higher standards of the people and companies involved in healthcare, when in reality, this is just one of the many everyday ways in which we screw the developing world.

The World Health Organisation estimates that half of HIV transmissions in Thailand come from contact between sex workers and their clients. There are said to be 2 million women and 800,000 children under 18 working in the sex trade, and much of this trade is servicing western men. It doesn’t spread itself, you know.

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