Let's talk about drugs

I'm not sure how many people find the topic of the politics of pharmaceutics interesting, but I most certainly do. And its not just because I'm a nursing student, because the politics surrounding pharmaceutics extends beyond pharmacology and involves ethics, sinful human tendencies and an assortment of other interesting topics. I'm reading a book right now called The Skeptics Guide to the Global AIDS Crisis. Its written by Dale Hanson Bourke, who is a dedicated humanitarian and also happens to be a Christian. Her perspective on the HIV/AIDS crisis is particularly interesting because she combines her Christian worldview with a realistic view of the magnitude of the crisis. Sometimes I think the church is a little disillusioned in terms of the global impact of HIV/AIDS. This virus effects every aspect of everything, and Bourke acknowledges that fact. Her writing is quite remarkable. At any rate, the purpose of this post was to talk about anti-retroviral drugs and the unfortunate controversies that surround them. Not only do I want other people to know about this topic, but I currently have so many questions and ideas bouncing around in my head, I think it might help to type it all out. And we're off.

 Anti-retroviral therapy (ART) is a combination of anti-retroviral drugs that help slow the proliferation of the HIV virus and the progression of AIDS.  Studies have shown that these drugs can reduce illness and death in HIV positive individuals by up to 70%. By no means are ARVs a cure for AIDS, but they most certainly improve the quality of life and may prolong the life of HIV positive people. Not only that, ARVs also help prevent mother to child transmission (MTCT) of the virus. Furthermore, because ARVs help lower the viral load in an infected individual, they essentially make that person less infectious (although, they are still able to transmit the virus and the use of ARVs does not justify sexual promiscuity or other reckless behavior).

So, although ARVs don't cure AIDS, they most certainly are beneficial for the HIV positive population. Are you ready for a depressing statistic? Globally, antiretroviral drugs reach only one in five of the people who need them. Disgusting, huh? So let's talk about why life-saving drugs aren't accessible to the people who need them the most. It comes down to politics and human greed. Most AIDS drugs were developed by Western pharmaceutical companies, and under international law have patent protection for twenty years. There has been great international frustration over the inability to obtain ARVs at an affordable price, especially in mass quantities.  In order for a patented drug to be produced, the manufacturer must pay a patent fee. Because of this patent fee, name-brand drugs are more expensive. Now the US government will only distribute name brand drugs (i.e. those protected by patents), based on "concerns for safety and efficacy". Name brand ARVs are significantly more expensive than generic drugs, even though the generics have the same chemical properties, produce the same effects and are approved by WHO and UNAIDS. So basically, because the US insists that name brand drugs be utilized in the programs that they fund, far fewer people are able to be treated.  

To aggravate matters further, the US government will also not endorse a new pill that combines the ingredients of three main ARVs into one pill. In order for antiretroviral therapy to be effective, several antiretroviral drugs must be used in conjunction.  Patient compliance and adherence to a specific regimen is increased when patients have a simpler regimen. If patients are able to take less pills everyday, they are more likely to take them and take the correct dose at the correct time. But because such combinations aren't marketed by any of the major pharmaceutical companies, the US government won't use these new super pills.  So because pharmaceutical companies in the West developed a majority of the widely used AIDS drugs and they're patented, generic/cheaper drugs which serve the same purpose are not used. Even if the US were to begin using generic drugs to fight AIDS because the drugs are patented, making the drugs generically is technically illegal. But alas, there is a loophole.

Lets talk about the World Trade Organization (WTO). Who are they and what do they do? According to Bourke "The World Trade Organization sets the rules, enables trade, and negotiates disputes between member countries. It is the primary body overseeing international trade agreements". How does the WTO affect antiretroviral therapy and the fight against HIV/AIDS you ask? Well, the WTO's main involvement has been in relation to the intellectual property rights that pharmaceutical companies have over their drugs and whether countries are allowed to legally violate patents in order to access life-saving generic drugs. Technically, the law is that all countries must comply with patent protection measures involving pharmaceutics. However, there is a loophole to this law, which is titled the Doha Declaration.  The Doha Declaration is "a provision of the agreement that allows countries to declare a public health emergency and thereby bypass certain patent protections". This is what permits countries to legally manufacture or import generic drugs before patent protections have expired. But the US doesn't use these drugs because they are generic and haven't been approved by the FDA.  

 Logically, this leads to the accusation that the US is protecting business interests over saving lives. The US takes the position that they don't want to promote the use of unsafe drugs. Its just all so complicated, and does it really need to be? Did there ever need to be a patent on life-saving drugs in the first place? Since when did saving lives become a business? Who decided that one company can control a chemical compound that can save lives? Why would anyone want to restrict access to life-saving drugs for monetary gain? Its just all so tragic. Now I understand the importance of patents. If something is someone's own idea or discovery, they have the right to protect it and get credit for it. But I always thought this applied to things like refrigerators and roller skates, not life-saving drugs. Sure, if you created a special kind of shampoo that makes hair grow exceptionally fast you have the right to control who copies you and what not. But shouldn't that right change when someone's life is on the line and when the world is being confronted with a public health crisis? 

Yea. So that was a long post. Below are some statistics/quotes that I've collected from Bourke's book as well as other internet sources (WHO and UNAIDS). They're interesting. Don't just read them as a bunch of numbers, as you read them acknowledge that the numbers represent human lives.

Grace and peace.

Hillary

-An estimated three million people die each year from AIDS, a death toll that has been compared to twenty fully loaded 747s crashing every single day for a year.

-Globally, approximately 50 percent of all HIV-positive people are female; in sub-Saharan Africa it averages nearly 60 percent.

-Nine out of ten children living with HIV and AIDS are African.

-While Sub-Saharan Africa is home to only 10 percent of the world's population, nearly 70 percent of those infected with HIV/AIDS live there. (WOW!)

-Without treatment [with ARVs], between 15 to 30 percent of babies born to HIV positive mothers are infected.

-By 2010, it is estimated that there will be 25 million AIDS orphans in the world.

-Nearly 6,000 young people between the ages of 15 and 25 are infected by HIV everyday.

-In India, 5.7 million people are estimated to be infected with HIV, making it the country with the greatest number of infections in the world.

-Of the 950,000 people living with HIV in the US, as many as a quarter do not know they are infected. [Hits a little close to home, huh? Yea, its not just a problem in the third world]

-Every day 1,500 children become infected with HIV.

-By 2010, more than 10 million people could be infected in China if current infection rates continue.

-In Botswana, life expectancy decreased from 65 years in 1985-1990 to 40 years in 2000-2005.

-Every minute a child under fifteen dies of an AIDS-related illness. Every minute another child becomes HIV-positive. [How long did it take you to read this blog post?]

-Worldwide, 80% of women newly infected with HIV are practicing monogamy within a marriage or a long-term relationship. 

-In Russia, heroin is often cheaper than alcohol and is one of the primary reasons HIV infections have risen dramatically.

-Even though Uganda has significantly reduced the rate of HIV infections, its AIDS orphan population continues to grow because previously infected people continue to die.