People in Third World die of curable diseases as Western drug companies create ‘lifestyle drugs’
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One old, fat, bald, fungus-ridden rich man who cannot get an erection means more to the pharmaceutical industry than half a billion poor people vulnerable to malaria. And almost three times as many people - most in tropical areas of the Third World - die of preventable, curable diseases as die of AIDS. Malaria, tuberculosis, acute lower respiratory infections claimed 6.1 million lives in 1998. People died because the drugs to treat those illnesses are non-existent or are no longer effective. They died because it does not pay to keep them alive.
One old, fat, bald, fungus-ridden rich man who cannot get an erection means more to the pharmaceutical industry than half a billion poor people vulnerable to malaria. And almost three times as many people - most in tropical areas of the Third World - die of preventable, curable diseases as die of AIDS. Malaria, tuberculosis, acute lower respiratory infections claimed 6.1 million lives in 1998. People died because the drugs to treat those illnesses are non-existent or are no longer effective. They died because it does not pay to keep them alive.
Certainly, the majority of the other 1,210 new drugs help relieve suffering and prevent premature death, but some of the hottest preparations have nothing to do with matters of life and death. They are lifestyle drugs - remedies that may one day free the world from the scourge of toenail fungus, obesity, baldness, face wrinkles and impotence. The market for such drugs is worth billions of dollars a year and is one of the fastest-growing product lines in the industry.
Western interest in tropical diseases was historically linked to colonisation and war, specifically the desire to protect settlers and soldiers. Yellow fever became a target of bio-medical research only after it began interfering with European attempts to control parts of Africa.
"So obvious was this deterrence ... that it was celebrated in song and verse by people from Sudan to Senegal," Laurie Garrett recounts in her extraordinary book The Coming Plague. "Well into the 1980s schoolchildren in Ibo areas of Nigeria still sang the praises of mosquitoes and the diseases they gave to French and British colonialists." U.S. military researchers have discovered virtually all important malaria drugs. Chloroquine was synthesised in 1941 after quinine, until then the primary drug to treat the disease, became scarce following Japan's occupation of Indonesia.
The discovery of Mefloquine, the next advance, came about during the Vietnam War, in which malaria was second only to combat wounds in sending U.S. troops to the hospital. With the end of a ground-based U.S. military strategy came the end of innovation in malaria medicine.
The Pharmaceutical Research and Manufacturers of America (PHARMA) claimed in U.S. newspaper ads that its goal is to "set every last disease on the path to extinction:" Spokesperson Jeff Trewhitt says U.S. drug companies will spend $24 billion on research this year and that many firms are looking for cures for tropical diseases. Some companies also provide existing drugs free to poor countries, he says.
The void is certainly at hand. Neither the pharmaceutical manufacturers association nor individual firms will reveal how much money the companies spend on any given disease - that's proprietary information. But on malaria alone, a recent survey of the 24 biggest drug companies found that not a single one maintains an in-house research programme, and only two expressed even minimal interest in primary research on the disease. "The pipeline of available drugs is almost empty," says Dyann Wirth of the Harvard School of Public Health, who conducted the study. "It takes five to 10 years to develop a new drug, so we could soon face (a strain of) malaria that's resistant to every drug in the world."
A 1996 study presented in Cahiers Sante, a French scientific journal, found that of 41 important medicines used to treat major tropical diseases, none was discovered in the '90s and all but six were discovered before 1985. Contributing to this trend is the wave of mergers that has swept the industry over the past decade. Merck alone now controls almost 10 per cent of the world market.
Share price
"The bigger they grow, the more they decide that their research should be focused on the most profitable diseases and conditions," one industry watcher says. "The only thing the companies think about on a daily basis is the price of their stocks. And announcing that you've discovered a drug (for a tropical disease) won't do much for your share price." That comment came from a public health advocate, but it's essentially seconded by industry. "A corporation with stockholders can't stoke up a laboratory that will focus on Third World diseases, because it will go broke," says Roy Vagelos, the former head of Merck. "That's a social problem and industry shouldn't be expected to solve it."
Profit
Drug companies, however, are hardly struggling to beat back the wolves of bankruptcy. The pharmaceutical sector racks up the largest legal profits of any industry and it is expected to grow by an average of 16 to 18 per cent over the next four years, about three times more than the average for the Fortune 500. "It's obvious that some of the industry's surplus profits could be going into research for tropical diseases," says a retired drug company executive, who wishes to remain anonymous. "Instead, it's going to stockholders."
And to promotion ($10.8 billion on advertising in 1998). And to politics. (American drug companies spent $74.8 million in 1997 to lobby the U.S. government. In 2001 they spent nearly $12 million on campaign contributions.) Just 45 years ago, the discovery of new drugs and pesticides led the World Health Organisation to predict that malaria would soon be eradicated. By 1959, Garett writes in The Coming Plague, the Harvard School of Public disease was passe that its curriculum didn't offer a single course on the subject.
Resistance to existing medicines - along with cutbacks in health care budgets, civil war and the breakdown of the state - has led to a revival of malaria in Africa, Latin America, Southeast Asia and, most recently, Armenia and Tajikistan. The World Health Organisation describes the disease as a leading cause of global suffering. For the drug companies, the meagre purchasing power of malaria's victims leaves the disease off the radar screen.
Among the problems the pharmaceutical companies are scrambling to eradicate are:
Impotence. Pfizer invested vast sums to find a cure for what Bob Dole and other industry spokespersons delicately refer to as "erectile dysfunction." The company hit the jackpot with Viagra, which racked up more than $1 billion in sales in its first year on the market. Two other companies, Schering-Plough and Abbott Laboratories, are rushing out competing drugs. Baldness. The top two drugs in the field, Merck's Propecia and Pharmacia & Upjohn's Rogaine had combined sales of about $180 million in 1998. Toenail fungus. With the slogan "Let your feet get naked!" as its battle cry, pharmaceutical giant Novartis recently unveiled a lavish advertising campaign for Lamisil, a drug that promises relief for suffers of this unsightly malady. The war against fungus involves a market estimated to be worth hundreds of millions of dollars a year. Face wrinkles. Allergan earned $90 million in 1997 from sales of its "miracle" drug Botox. Injected between the eyebrows at a cost of about $1,000 for three annual treatments, Botox makes crow's feet and wrinkles disappear. "Every 7½ seconds someone is turning 50," a wrinkle expert told the Dallas Morning News in an article about Botox last year. "You're looking at this vast population that doesn't want frown lines." Older medications
Meanwhile, acute lower respiratory infections go untreated, claiming about 3.5 million victims per year, overwhelmingly children in poor nation. Such infections are third on the chart of the biggest killers in the world; the number of lives they take is almost half the total reaped by the Number One killer, heart disease, which usually strikes the elderly.
n some cases, older medications thought to be unnecessary in the First World and commercially unviable in the Third have simply been pulled from the market. This created a two-year crisis recently when TB re-emerged with a vengeance in US inner cities, since not a single company was still manufacturing Streptomycin after mid-1991. All the blame for the neglect of tropical diseases cannot be laid at the feet of industry. Many Third World governments invest little in health care, and First World countries have slashed both foreign aid and domestic research programmes.
Meanwhile, the U.S. government aggressively champions the interests of the drug industry abroad, a stance that often undermines health care needs in developing countries. Given the industry's profitability, it's clear the companies could do far more. It's equally clear that they won't unless they are forced to. While the industry's political clout currently insures against any radical government action, even minor reforms could go a long way.
At the beginning of this year, Doctors Without Borders unveiled a campaign calling for increased access to drugs needed in Third World countries. It's exploring ideas ranging from tax breaks for smaller firms engaged in research in the field, to creative use of international trade agreements, to increased donations of drugs from the multinational companies. Campaign organiser Dr. Bernard Pecoul says different approaches are required for different diseases. In the case of those plaguing only the Southern Hemisphere - sleeping sickness, for example - market mechanisms won't work because there simply is no market to speak of.
Too expensive for people in the Third World.
He suggests that if multinational firms are not willing to manufacture a given drug, they transfer the relevant technology to a Third World producer that is. Drugs already exist for diseases that ravage the North as well as the South - AIDS and TB, for example - but they are often too expensive for people in the Third World.
For 25 years, the World Health Organisation has used funding from member governments to purchase and distribute vaccines to poor countries. Pecoul proposes a similar model for drugs to treat tropical diseases. Another solution he points to: In the event of a major health emergency, state or private producers in the South would be allowed to produce generic versions of needed medications in exchange for a small royalty paid to the multinational license holder.
"If we can't change the markets, we have to humanise them," Pecoul says. "Drugs save lives. They can't be treated as normal products."
(KEN SILVERSTEIN, The Independent, November 29, 2004)
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