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AIDS, Healthcare Costs, and the Pharmacuetical Companies
Without starting a huge political debate, can we discuss the costs of patented medicines?
I'm reading There is No Me Without You, and it's been my first introduction to a lot of things about the history of AIDS and the worldwide fight against it. It also is a pretty strong indictment of the US government and those of other developed countries for not doing what they could to make life-saving medications more accessible to the poor countries in which it was needed most. Much of the information is very new to me, and I was wondering if anyone here is familiar with and wanted to discuss some of the main points.
Among other things, she discusses:
1) that the human form of HIV/AIDS may have originated through vaccination campaigns which used reused unsterilized needles, allowing the mild, non-life-threatening version of the virus to mutate many times rapidly and become a much stronger, resilient virus;
2) that the research for the first "triple cocktail" which put AIDS at bay and later medicines were developed using public research, but were patented by private companies which set their prices as high as they would for drugs which were the result of their own proprietary information/research (compensating them for the time/money spent); and
3) that the US and other governments strongly defended these patents and the resultant pricing, to the point of issuing sanctions against South Africa for seeking means to cheaper access.
I am so intrigued by all of this, and the depth of her annotations and breadth of her sources leads me to believe that she's not just making most of this up. Can anyone confirm/deny any of this?
I'm still only partly through the book, but this is all background information to the main story, and I'm fascinated. If it's all true, it makes me think that maybe the pharmaceutical companies really are the ones that are to blame for the ever-rising healthcare costs, and not the insurance/malpractice issues. Of course, it's likely a combination of the two, but reading this book has really changed my opinion of pharma as a business.
Re: AIDS, Healthcare Costs, and the Pharmacuetical Companies
I am not familiar with the book but it is interesting to me based on what you have said here.
It does not shock me about points 2 and 3.
Nothing shocks me anymore.
I have a good friend from childhood, my brother's BFF, who was diagnosed with Lou Gherig's Disease. There is no cure, but there is some research that shows drinking sodium chlorite (I believe) will stall the effects of the disease. However, because you cannot patent an ion, no drug companies are picking this up to produce it. They can't make money off of it. So instead, he is part of a drug study, which is great for him. But what do you do for the guy that lives in mid-Idaho and has no access to be a part of drug studies?
This doesn't make any sense to me from a scientific standpoint. Maybe I need to read the book, but I can't parse this into any sort of tenable evolutionary pressure theory.
Happens all the time. NIH gives out funds for the basic science research to universities and other research institutions, researchers make discoveries, then universities license their technology to companies to make the drugs and do trials, etc. University thus gets some extra $$ to reinvest in research, drug companies get profits if there are any - but they also take on the licensing, manufacturing, and trials expenses.
Private companies can't patent the work of someone else, though. They could have patented improvements (ie, dosage, etc) determined during trials, as is the norm.
I don't find it shocking, but then this isn't new info to me. None of this is exclusive to the HIV/AIDS virus. And, most people in the pharma IP world are of the opinion that this sort of profit system is directly fueled by our private healthcare system. There is a lot of chatter that this (meaning public funds -> private profit) needs to be reformed, but I'm not sure how you'd do it. Universities don't have the capability to manufacture drugs and run the huge expensive trials, so what do you do? Require drug companies to do this pro bono? Set a statutory profit margin? How do you ensure that these drugs get fully tested, made, and released if there isn't something in it for the drug company?
I'm not saying that I think it's moral or ethical. I'm just saying it's complicated.
Intellectual property is only valuable if you have the right to exclude. Again, I'm not saying I agree with the response (especially because I don't know the details), but there is an international IP treaty and if South Africa is a part of it (not sure but they probably are), I could see why the US Government would have an interest in their compliance.
Hmm, I disagree. At least Pharma adds value to the system: they make, test, and manufacture the drugs. There is a TON of risk. Insurance companies, on the other hand, well those guys just push paper around and collect the checks.
Malpractice is a drop in the bucket compared to the insurance company margins. Tort reform isn't going to reign in healthcare costs any more than cutting the NPR budget is going to fix the federal deficit.
The poster formerly known as PDXPhotoGrl
The theory behind the origin of AIDS goes something like this (I hope I get this right):
The simian HIV virus had been found in humans, but was never fatal and was fairly mild. When penicillin became was widely available, it was generally administered as a shot, but needles were expensive and there was a supply shortage (this was before the disposables were available), so the same needles were used over and over. Unfortunately, the needles were often not properly sterilized. Doctors in many African countries began using penicillin to treat just about everything, right down to the common cold. Then WHO and other international health organizations began vaccination campaigns, but didn't provide the needles (the book mentions one documented case as an example, in which a single "doctor did five hundred people in two hours using six needles, and [the syringes] were just thrown into a bath of alcohol").
The theory is that contaminated needles spread infected blood from human to human at a very rapid rate, allowing the virus to become resilient in record time. The quote below is from two doctors who came up with the theory that "serial passage" of the simian virus created human HIV/AIDS, Drs. Preston Marx and Ernest Drucker.
"But if?during that period while it's still trying to adapt?you were to share some of the person's blood (which is basically what a dirty injection does) you passage some of that partially mutated virus to a second person. And that second person picks up where the first one left off. The virus is now partly adapted to humans, and it's able to live a bit longer. So that second person moves it forward a little closer to HIV. And then you do that one more time and one more time . . . and each time you passage the virus it gets more and more pathogenic, it adapts to the new host. And by four or five or six passages later, you have one that actually is adapted to the human host; it begins to replicate, it begins to shed off viral particles, [it becomes] infectious to another human being."
Greene, Melissa Fay (2008-12-12). There Is No Me Without You: One Woman's Odyssey to Rescue Her Country's Children (p. 81). Bloomsbury Publishing Plc. Kindle Edition.
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This doesn't just happen in medicine/pharm, it's with tech too. Professors I worked for would create new technology using grant money from the government, then it would either be licensed out to an existing company, or sometimes they would start a new company using the new technology.
And if we're talking about healthcare costs and drug companies and drug company expenses, I think you have to mention the over the top amount of advertising that goes on for prescription drugs. Levitra contracting with the NFL, paying Rafael Palmiero to shill Viagra, reps all over hospitals, that shiit ain't cheap. That pushes up the cost of drugs an awful lot across the board.
Also, if you're interested in the AIDS history stuff, And The Band Played On is fantastic, and also goes into the issues of competition in science and how people working on the same issue at different institutions sometimes refuse to collaborate because they don't want to share the scientific discovery cred.
The more I learn it happens, the more disturbing it seems. I'm not sure how to rectify it, but it feels like bad policy and a violation of human rights.
Noisy, I may check that out after some time. This book is so heavy. It's about a woman who single-handedly took in over a hundred AIDS orphans in Ethiopia, but got really into the history of Ethiopia and the AIDS epidemic, as well as the individual stories of many of the children. After this, I think I'll need a break for a while and some lighter reading material, like maybe The Decline and Fall of the Roman Empire, or something.
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I'd be interested in picking your brain about (and I'm sure this is the most awkward way to phrase it) re-patenting drugs that have lapsed patents but underserved markets in the hopes that profitability will ensure needed drugs continue to be developed. I don't have a good alternative to suggest, but it seems like it's a situation ripe for abuse. Especially when it hits a small fraction of the population.
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I feel like a large part of the problem is that we don't see healthcare as a public good the way we do basic education and public safety. Not that there isn't unnecessary rivalry, waste or corruption in those fields either, but because of a recognition of mutual goals there is more cooperation and drive to serve all (if not always equally). That we can't seem to get there with healthcare on a system-wide basis shows what a wrong direction we're heading.
I don't know that it has to be a single payer system, but I won't be convinced we can keep it private and a workable system unless there's a way to instill that sense of public service. Can anyone think of a business model that provides that?
"The meek shall inherit the earth" isn't about children. It's about deer. We're all going to get messed the fuckup by a bunch of cloned super-deer.- samfish2bcrab
Sometimes I wonder if scientists have never seen a sci-fi movie before. "Oh yes, let's create a super species of deer. NOTHING COULD POSSIBLY GO WRONG." I wonder if State Farm offers a Zombie Deer Attack policy. -CaliopeSpidrman