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In defense of big pharma

By Greg Pomeroy
web posted July 2, 2001

Of the 36 million people infected with HIV, 26 million live in Africa with another person there added every 25 seconds. It isn't easy to see the pictures of the suffering or hear the stories without feeling a deep sorrow. The sadness turns to frustration when we realize that there are drugs that can prolong and improve an HIV-positive person's life that simply aren't getting to those who urgently need them. We should keep one thing in mind, however, as we ponder the problems and our emotions move us: The pharmaceutical companies that are working for a cure, despite their vilification, are the closest thing we have to heroes in the fight against AIDS.

About the time of the first reports of AIDS 20 years ago, I witnessed a scene in a McDonald's restaurant that seemed small, but it has stuck with me and directly relates to the AIDS situation today. I was 14 years old, and as I ate with my family a little girl, maybe 8 years old, walked into the restaurant. She walked up to the counter and said in a loud voice, "I want a hamburger. Give me a hamburger. I'm hungry." She was shabbily dressed and a little dirty. The woman in the McDonald's uniform behind the counter argued gently with her, and the manager eventually came over and argued with her as well. The girl begged, cried, and became quite angry. And she finally left without her hamburger. As I watched this I knew that there were McDonald's all over the country and a hamburger or two would not be missed, but I also knew that if the manager had reached across and handed the girl some food, it would undermine, in some small way, everything McDonald's was in business to do.

The big drug companies, the ones working on an AIDS cure, are being vilified today because they refuse to give their products away. They simply refuse to reach across counters, or continents, and give their patents or medicines away. McDonald's we know, but who exactly are these companies? They are the global pharmaceutical companies in the United States such as Pfizer, Merck, American Home Products and Amgen, as well as GlaxoSmithKline of the United Kingdom. They have developed the myriad drugs that are helping in the fight against AIDS around the world. Pfizer is the biggest of the big with a market capitalization of $274.4 billion. GlaxoSmithKline is next with a market cap of $172.1 billion. By way of comparison, the global hamburger vendor McDonald's (you can order a Big Mac in 120 countries) has a market cap of only $39.2 billion.

The critics of these big drug companies contend that the companies are more interested in profits than in ending the AIDS endemic. A business that is not in it for the profits is not in business. But this is a false choice anyway because the profits of these companies are directly linked to finding a cure; they can't care about one without caring about the other. Or, put another way, ending the pestilence or boosting profits, to a Pfizer or Merck, is the same thing. The only people in the world more desperate for a cure are the sufferers themselves. Asking these companies to ignore their profits and give away their products is the most myopic of solutions in a battle against a disease that has already lived and thrived 20 years. Should we ask McDonald's to give away hamburgers to people dying of starvation in Africa simply because McDonald's produces hamburgers? Should American and European construction companies be forced to build them houses for free? No one would even suggest it.

A poorly equipped clinic in Africa
A poorly equipped clinic in Africa

Even if these pharmaceutical companies decided to simply give away what has taken them years of intense research and enormous amounts of money to develop, it would not solve much of anything for most Africans with HIV. The first problem would be the lack of infrastructure, such as roads and trucks and gasoline and even phones, to get the medicine to those who need it. Finding a doctor to prescribe the right amount of the 30 or so pills a day is the second problem; we couldn't run about the African countryside tossing out handfuls of medicine like the queen of a parade tossing out candy along the parade route. The third problem would then be trying to get the patients to take each of those 30 pills at the right time of day, and with or without the right food. This is made more complicated, of course, by the fact that the poor of Africa, an overwhelming majority in most countries, have a hard enough time just getting the right food.

And even if the big pharmaceutical companies gave away their products and we found ways to ensure that the patients who received them took the medicine properly, would this really be the best answer at this point in the fight? One of the most insidious characteristic of AIDS, second only to the fact that it kills, is that the victim doesn't die quickly but lives long enough to infect and kill others. If AIDS killed on contact, we would hardly have a problem with it because it would not be passed on and on and on. If the impoverished of Africa who have AIDS lived an extra 10 years and nothing else changed, it would only mean that more people would be infected and die, not less. AIDS treatment must go hand in hand with intensive education and strong pressure for a change in behavior. If one African man with AIDS did live 10 years longer and he infected 5 more people during that time, would this be an advance in the fight? Absolutely not. The easy answer is to blame the drug companies for not giving away the AIDS drugs to those who are quite literally dying for them, when, sadly, there simply are no easy answers.

The big drug companies, despite their wherewithal, are not responsible for the health of the African people; these companies, like all companies, are responsible for contributing to the financial health of their shareholders. But there are people who are responsible for the health of HIV-infected people in sub-Saharan Africa: the national leaders of these African countries. To usurp their responsibility to their people, even with the best of motives, is a short-term answer that in itself creates long-term problems. On September 12, 1999, 10 African nations declared AIDS a national disaster and pledged themselves to, among other things, provide political leadership and increase resources. If nothing else, this firm acknowledgement of responsibility is the first hesitant step in a long journey toward incarcerating, if not fully executing, a diabolical serial killer.

Greg Pomeroy is a high school educator and free-lance writer living in Knoxville, Tennessee.

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