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How Not to Fight the Next Epidemic

Ken Nesmith

Few arenas host a more motley collection of stakeholders than the international drug trade. Entrepreneurs, research scientists, various political bodies, doctors, drug companies, victims of disease all are participants in a somewhat cacophonous dialogue over drug therapies. Recent developments in the discussion may sow the seeds for a frightening and tragic future, borne of unwillingness or inability to perceive and comprehend the creation of a drug.

Thanks to ignorance, poor sexual decisions, and occasionally, plain old bad luck, millions of individuals worldwide are afflicted with the AIDS virus. Treatment has come a long way in the past decades, as research efforts by pharmaceutical companies have dramatically reduced the number of pills and frequency of dosage involved with drug therapy. These drugs perform the quite impressive task of lending life to the doomed, staving off one of nature’s most powerful assaults on the human body, and their cost can be exorbitant, although it continues to fall.

The drugs are not necessarily expensive to manufacture. Their expense lies in the years of labor, research, trial, and failure that it takes to produce the simple little pills. Generic producers do not bear such costs. They need merely throw the proper chemicals together to create the pills. They have no part in figuring out just which chemicals will make a good pill. The pills they create, however, are identical to the expensive ones sold by drug companies. The disparity in price can be staggering: one day’s dose of the antifungal drug fluconazole, for instance, sold for $18 directly from the drug companies that produced it, but 30 cents from a generic producer in Thailand.

Generic producers are like the Kinko’s of the drug world. Take a book to Kinko’s, run it through a copy machine, and what comes out is a completely usable text: all the knowledge, entertainment, insight, enlightenment, and whatever else is to be found in a given book is equally present in the Kinko’s copy. Its cost is splendidly low: rather than the tens of dollars a book might cost at the bookstore, a Kinko’s book only costs a few dollars for paper and ink. What if our new model of book commerce was to buy all of our books from the copyshop? It seems like a good policy: the books work just as well, and they’re dramatically cheaper than ripoff bookstore prices. Why should anyone, especially those in need, pay exorbitant prices for simple paper and ink when Kinko’s can do it for a few bucks?

In the Kinko’s Bookstore world, we would very quickly have no more books to copy. In our crusade for economic justice in the world of books, we’d have forgotten that authors write the words on pages. Once we decide to steal their work, they probably won’t write much more of it -- even if not for lack of will, for lack of means. We’ve replaced a free trade of money for books with an act of larceny, by taking what we want, when we want it, without consent. Even if we really want the books, even need them, expropriating them amounts to theft. And it destroys the very act of creating books.

No matter the need, no matter the circumstance, refusal to understand creation and production ensures the destruction of those activities. Even if we really need cars to drive longer distances, bribing the security guard to let us take them from the dealer’s lot is an act of theft, and a good way to ensure the eventual end of car dealerships. Even if all of us students get really hungry, paying a food court employee to let us cart away a rack of Odwalla bars and maybe some muffins on a daily basis will ensure that there will soon be no more food to take. And today, even if millions have contracted a terrible disease, cannibalizing the industry that can offer a cure will destroy that industry, and make it impossible to create new drugs. Who, after all, would invest the massive scientific and capital resources, the sheer effort and struggle, to create a new drug if once they found it, it was to be taken from their hands for free use by any who could mix chemicals?

These analogies border on stultifying, but it seems that the simple logic behind them is absent the current discussion. Quite impressively, the terms of the debate have shifted such that the question is not whether or not generic producers will be allowed to expropriate drug patents, but how much they’ll be able to do it. Drug companies, despite ongoing innovation, constantly falling costs, and even outright giveaways of cutting-edge drugs to poor countries, have been forced to play along without recourse. The language of an Aug. 29 New York Times article analyzing a World Trade Organization proposal to allow more generic drug production indicates just how far the terms of discussion have shifted. The new agreement, lambasted by activists as “cosmetic” and a “concession” to drug companies, gives national governments control over the drugs produced by drug companies. A country needing an AIDS drug need only ask the government of a country that produces a generic version to export it without the patent holder’s permission. It also describes Brazil’s AIDS program, which serves 135,000 patients with free drug cocktails, as possible because “the country makes its own generic drugs and uses the threat of local production to force multinational producers to lower their prices on others.” This policy -- give it to us, or we’ll steal it -- is portrayed as an innovative and effective one.

Drug companies have to respond to these new policies by recovering their costs elsewhere, and for now, that’s still possible in the United States. Those afflicted with AIDS who are not getting their drugs from generic producers are paying for their own pills as well as subsidizing generic pill production. This arrangement, a de facto progressive taxation imposed on AIDS victims, is itself under threat. Pressure continues to build to allow importation of drugs from foreign countries like Canada. Proponents make their case by comparing the cost of drugs abroad to the higher costs in the United States. Political realities have forced opponents to spin this as a safety issue, portraying imported drugs as unregulated and potentially unsafe. It’s a claim that borders on xenophobic; what is striking is that it’s not possible to argue the truth in this political atmosphere: drug prices are cheaper abroad because they’re under government price controls. Allowing importation effectively extends those controls to the U.S. market, where drug companies currently make the money they need to remain fully operational. The eventual consequences are obvious: a dramatic curtailment of new drug production.

Yet the media’s analysis of long-term versus short-term considerations is quite different. A July 17, 2000 article from Time Europe describes drug giveaways as short-term solutions that are “only effective for the duration of the program.” The long-term answer? Creating a “stronger emphasis on generic drugs at a fraction of the cost of name-brand equivalents.” Time’s long-term solution to fighting disease is to destroy the process of drug creation, often the only weapons we have in the war against disease.

Drug companies have no moral responsibility to fight diseases and make their products freely available, no more than IBM has a moral responsibility to develop new computers that save lives. It is a blessing that their products exist. However, if we refuse to understand how drugs are made, and we choose to cannibalize the work of those who invent new drugs, we will destroy them. That will work to address current threats for a while, until a new epidemic spreads. Therein lies the real risk: by destroying the infrastructure of drug creation and distribution, we will hobble our ability to face unforeseen threats. The massive, destructive impact of AIDS makes it all the more tempting to expropriate needed drugs. Doing so makes us surrender the very tools that allow us to fight diseases like AIDS in the first place.

Most of us can be fairly certain we’ll avoid contracting AIDS, but future biothreats will surely employ methods of transmission that don’t depend so strongly on our personal choices. We’ll need a robust pharmaceuticals industry armed with the resources to address those threats. The current political pathways will leave us with skeletons of research and development programs, and strong aversions to the risks associated with drug development (some of which regulators impose). We should indeed be very careful with our treatment of generic drugs.