Healthy Skepticism Library item: 19990

Warning: This library includes all items relevant to health product marketing that we are aware of regardless of quality. Often we do not agree with all or part of the contents.

Publication type: news

Berwick DM
The World has AIDS, So make the Medicines Free
The International Heerald Tribune 2001 Jun 27

Full text:

The Nazis ordered Jews to wear a yellow star as prelude to their destruction. But not in Denmark. According to legend, King Christian X threatened that if Danish Jews were to wear the star he would too. The story is almost certainly a myth, but its meaning is not. Despite the occupation, Denmark rescued the overwhelming majority of its Jews. “If some Danes are under siege”, the story means to say “then all Danes are under siege”.

Now we all have AIDS. No other construction is any longer reasonable. The earth has AIDS – 36.1 million people at the end of the year 2000.

Three million humans died of AIDS in the year 2000, 2.4 million of them in sub-Saharan Africa. There have been more deaths since the AIDS epidemic began than in the Black Death of the Middle Ages. It is the most lethal epidemic in recorded history.

Prevention will be the most important way to attack AIDS everywhere, but treatment matters too. We can treat AIDS effectively. We cannot cure its victims but we can extend their healthy lives by years – with luck, by decades. We can reduce its transmission from infected mother to unborn child by two-thirds or more.

We see the effects of advancing science plus enlightenment public health policies in the United States, where the AIDS toll began to fall in 1997.

Successful, life-prolonging management of HIV infection is not simple. Important dimension include education, social support and lifestyle interventions that are extremely difficult to achieve in the development nations, and many times more so in impoverished nations. But it is a mistake to ignore the role of medications.

The mainstay of lifesaving care for the unborn child or the infected adult is medicine, given in a timely, scientifically accurate and reliable way.

Most people with HIV and AIDS do no get these medicines. The barriers are partly social and logistical, but the overwhelming barrier is cost. At current prices, one year of triple drug therapy for an HIV-positive person costs $15,000. Recent welcome changes by a few progressive pharmaceutical companies, such as Merck & Co., promise to reduce that cost by thousands of dollars per year.

But keep in mind that no legend claims that King Christian talked of putting on only half a yellow star.

Here is what the world needs: free anti-AIDS medicines. The devastated nations of the world needs AIDS medication at no cost at all, or, at a bare minimum, medicines available at exactly their marginal costs of manufacture, not loaded at all with indirect costs or amortised costs of development. No hand-waving or accounting manoeuvres. For all practical purposes, free.

Here is how it could happen: The board chairs and executives of the world’s leading drug companies decide to do it, period.

To anxious corporate lawyers, incredulous stockholders, cynical regulators and the suspicious public they say, together, the same thing: “The earth has AIDS, and therefore we all, for now, have AIDS. Therefore, we are taking one simple action action that will save millions and millions of lives. We choose to do it, together, and we will use the intelligence of our own forces to figure out how to make it possible, while preserving the futures of our companies”.

No one could stop them. No one would dare try. For the small profit they would lose, they would gain the trust and gratitude of the entire world. They would have created a story to be told for a millennium, and those who depend on the prudence of these leaders – on their “fiduciary responsibility” – might choose then not to blame them but to join them in celebration, as fiduciaries of humankind.

The names of people who can say this, together, include these: Raymond Gilmartin chairman and CEO of Merck & Co.; Sir Richard Sykes and Jean-Pierre Garnier, respectively chairman and CEO of GlaxoSmithKline; Charles A. Heimbold Jr. and Peter Dolan, respectively chairman/CEO and president of Bristol-Myers Squibb; Franz B. Humer, chairman and CEO of Roche.

These few souls would ultimately save the lives of more human beings than died in the Holocaust. The memory of the deed would probably outlive even the story of the Danish king who joined his people in their need.