TB, other poor’ diseases ignored by drug industry
Financial incentives necessary to grab attention
Something is wrong with the system, TB experts say. In the rush to produce remedies for hair loss, weight gain, and other gremlins that bedevil customers in rich countries, the pharmaceutical industry has overlooked a thing or two — namely, TB and the other serial killers that run rampant through poor countries.
"For decades, the government has taken care of basic science research, while industry has looked after development and brought products to society," says Ariel Pablos-Mendez, MD, MPH, scientific adviser to the Rockefeller Foundation and assistant professor of medicine at Columbia University in New York. "The model has worked well for some diseases, but the diseases of the poor have been left behind. Thus we have what you might call market failure."
Of the 1,223 new chemical entities registered between 1975 and 1997, only 11 are useful in treating the tropical diseases that strike hardest at those living in poor countries. For certain, the fact that Americans and Europeans together spend more than $220 billion a year on prescription medicines helps explain the gaping disparity.1
"The pharmaceutical industry has become increasingly commercialized, so what’s happening is, from the drug companies’ point of view, completely logical," says Francine Matthys, MD, medical director for the Belgium branch of Doctors Without Borders.
Logical or not, results for the poor have been disastrous — and never more so than in the treatment of multidrug-resistant TB. Capreomycin and cycloserine, two highly toxic, last-ditch drugs often used to treat TB resistant to first-line agents, are so breathtakingly expensive that the two drugs probably have produced more arguments than cures. Unable to persuade poor nations to invest even in relatively affordable first-line agents, policy-makers instead have engaged in anguished debates over whether patients sick with MDR-TB will die before they spread too much contagion to others.
But the drug industry isn’t solely to blame, some experts say. "This is only my personal opinion," says Matthys, "but I believe that there is something badly wrong with a society when the government abdicates responsibility for health care and begins to view health care as simply one more commercial product, no different from Coca-Cola."
Some observers believe the best way to effect change is by giving the drug industry exactly what it wants; for example, by using tax credits as incentives or simply by holding out enough money to grab the industry’s attention. (See related stories, pp. 124-125.)
"The drug companies have a choice: either to work on Rogaine or to work on a TB vaccine," says Michael Kremmer, PhD, professor of economics at Harvard University and a senior fellow at the Brookings Institution. "What you want to do is make it more attractive for them to work on TB."
Other TB experts say governments should pick up what the commercial market has abandoned. Perhaps, they say, what’s needed is the creation of a "parallel mechanism" for drug development.
Such a structure might entail a sort of sifting device, which would screen for anti-TB properties every taxpayer-financed discovery that comes out of bench science, says Jim Yong Kim, MD, executive director of the Cambridge-based program Partners in Health and co-director of Harvard Medical School’s program in infectious disease and social change. Whatever looks promising could be funneled straight into a special facility that would take promising agents through the lab and on to field trials, he adds.
"Sure, there are a lot details to be worked out," says Kim. "Figuring out exactly how to do this would be tough. All I know is that we need something different from what we have now."
Kim, Matthys, and several other physicians interviewed for this series hasten to add that since their work is so dependent upon the good will of pharmaceutical firms, the last thing they want to do is to anger the pharmaceutical companies by appearing to criticize them.
"The truth is, we need these guys," Kim says. "The way we’re trying to approach this thing is to say, Look, we’re just a bunch of doctors trying to get medicines for our patients.’ We’re asking them, the drug companies, to help us come up with a solution."
"Access to Essential Medicines," the campaign recently launched by Doctors Without Borders, promises to be less polite than individual physicians have been. One of the campaign’s chief aims will be to publicize the disparity in access to drugs between the rich and the poor, says Matthys. Spokesmen for the campaign add that the medical charity will team up with consumer advocates (such as ACT-UP, the noisy American-based AIDS activist group) and will take on touchy issues related to proprietary rights, including compulsory patent transfers to countries in urgent need.
Reference
1. Balms for the poor. The Economist, Aug. 14-20, 1999: 69-71.
You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content