[Ip-health] Giuliani's Awful Record on HIV/AIDS - response to Sally Pipes

[robert weissman]

Andrew Green at The American Prospect writes about the meaning of Sally
Pipes' op-ed in The Hill attacking the Brown/Allen resolution calling
for an end to US support for TRIPS-plus policies and a commitment to
explore new global norms to support biomedical R&D.

The Andrew Green piece is below. The original from Sally Pipes is at:
<http://thehill.com/op-eds/dont-commend-theft-of-aidsdrug-patents-2007-10-18.html>.
A letter from Brook Baker, previously posted to the list was published
and is available here:
<http://thehill.com/letters/standing-up-to-big-pharma-knowing-the-law-and-the-facts-2007-10-24.html>.

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http://prospect.org/cs/articles?article=giulianis_awful_record_on_aids

Giuliani's Awful Record on HIV/AIDS

One of Giuliani's health care advisors recently decried a plan to offer
cheaper HIV/AIDS drugs in developing countries. It's a good opportunity
to ask: What would U.S. AIDS policy look like in a Giuliani administration?

Andrew Green | November 15, 2007

Sally Pipes serves as president and CEO of the Pacific Research
Institute, a free-market think tank that draws some of its funding from
pharmaceutical companies. Given that bit of back story, imagine her
distress when the Thai government issued "compulsory patents" to its
domestic drug manufacturers at the Government Pharmaceutical
Organization (GPO) to copy and reproduce formulas for two antiretroviral
drugs.

Spurred to action, Pipes produced an alarmist screed in The Hill last
month charging that the Thai government rejected offers for cheaper
antiretrovirals and issued the patents primarily to enrich its cronies
at the GPO. In the op-ed, she also takes time to wag her finger at Rep.
Tom Allen, Sen. Sherrod Brown, and former President Bill Clinton, who
have publicly applauded the Thai government's action. Never mind that
Thai officials acted completely within the bounds of international law
and that their actions will likely make antiretrovirals available to
thousands more HIV/AIDS patients.

The point of Pipes' op-ed is to champion the importance of intellectual
property rights and minor corporate profits over cheap, effective
antiretroviral treatment in the form of generic drugs. She just buries
the callousness in hysteria and conjecture.

Of course it's unfortunate but not surprising that Pipes, a free-market
doctrinaire, would produce this piece. And were she just running a think
tank with pharmaceutical funding, it could be read as a shill piece and
dismissed. But there's a bit more to Pipes' biography: She is also a
health-care adviser to Rudy Giuliani, the leading Republican candidate
for president. (No relation to foreign-policy adviser Daniel Pipes.)
Suddenly her op-ed is not so much ridiculous, as frightening.

When she was appointed earlier this summer, Pipes seemed a natural fit
for the Giuliani health-care team, which consists primarily of
domestically focused, consumer-driven health-care proponents. Pipes had
already achieved some notoriety criticizing the state-level
health-insurance mandates and regulations backed by Republican
presidential candidate Mitt Romney when he was governor of
Massachusetts. Thus, her appointment had the benefit of telegraphing a
distinction between Giuliani and his main opponent to health-care
experts and policy wonks.

And that's about where her significance to this election cycle stopped
before her Hill op-ed. Save for taking a few more shots at Romney and
popping up occasionally to cheerlead for Giuliani, Pipes had drawn
little other attention. With a candidate who is reticent to outline any
specific health-care policies, it seemed that she (and the rest of
Giuliani's health-care squad) would hang out on the campaign sidelines.

It's unfortunate that she didn't stay there. Her op-ed can be read both
as a signal that her role is expanding and as a preview of the HIV/AIDS
policy she is encouraging Giuliani to adopt, specifically, one without
regard for the immediate need for as many cheap generic antiretrovirals
as possible. That in itself is a cause for concern. The real crisis,
though, is that Giuliani might actually be receptive to her arguments.

Up to now Giuliani's AIDS policy has been, at best, poorly defined.
Though he's expressed an interest in continuing and possibly expanding
the President's Emergency Plan for AIDS Relief (PEPFAR), it's apparent
Giuliani has thought little about what that actually means. He hasn't
outlined a prevention strategy or talked about whether he plans to
expand treatment options. When asked this summer about increasing
federal support for HIV/AIDS medications, Giuliani's convoluted response
touched on terrorism and his mayoralty, but did not include an actual
answer to the question. There's nary a mention of an HIV/AIDS policy on
his Web site. His lack of investment or concern about the issue leaves
him vulnerable to insiders like Pipes whose business-first agendas are
prepackaged.

Those assuming Giuliani's reputation for liberal social policies will
automatically translate into a progressive HIV/AIDS package should do a
rudimentary search through his mayoral record. It is littered with cuts
to AIDS programming and relief services, and feuds with activists. Near
the end of his second term, a federal judge ruled that Giuliani's
administration "chronically and systematically" delayed and terminated
benefits to thousands of people with AIDS. As a result, New York's AIDS
agency was placed under federal authority for three years. There's no
reason to think higher office will induce a heightened commitment to
assisting HIV/AIDS patients.

Just the opposite, it now seems. Having invited Pipes to whisper
free-market mantras in his ear (and direct large pharmaceutical
contributions into his pocket), it's increasingly possible Giuliani will
wind up with an AIDS policy that manifests her skewed morality.
Observing his effort to woo fiscal conservatives, it's not outlandish to
think he might make AIDS relief contingent on buying brand-name
antiretrovirals. Or that he would levy trade restrictions and financial
penalties on countries, like Thailand, that determine the best way to
immediately reach the most HIV/AIDS patients is to produce their own
antiretrovirals.

For the hundreds of thousands of people around the world who depend on
generic drugs, a Giuliani presidency could be profoundly tragic. Even if
it is imbuing too much influence in Pipes to read presidential policy
into her op-ed, it's still frustrating to be revisiting the debate over
generic antiretrovirals.

By now the international community -- including U.S. presidential
candidates -- should be committed to reducing the impact of the HIV/AIDS
pandemic in the most efficacious way possible. That means taking
advantage of antiretroviral-drug regimens currently in production that
will keep HIV/AIDS patients alive for years, even decades longer than
they otherwise would be.

But thanks to patent-holding pharmaceutical companies, those years come
with an outsized price tag. This is especially true of second-line
drugs, like those Thailand is producing, which are critical for patients
who have developed a resistance to earlier, first-line treatments.
Consequently, the best way to keep the most people alive is to buy and
distribute generic antiretrovirals, or as the Thai government has
decided, to produce the drugs domestically. They are almost always
significantly cheaper than the patented originals, and their price comes
without the haggling and without the commitments that the pharmaceutical
companies frequently demand in exchange for reduced prices.

AIDS activists and health officials already went a round with President
Bush over generic drugs. Though he was initially reluctant to distribute
generics under PEPFAR, eventually he relented and expedited the approval
process for generic and combination antiretrovirals. Despite the other
flaws in his AIDS-relief package, Bush does deserve credit for coming to
his senses. If Giuliani is elected, it would be tragic to waste the time
and the lives hoping he, too, will eventually come around.

In fact, all of the presidential candidates would be well served to
study the AIDS policy Democrat John Edwards has introduced -- the only
candidate from either party to put forth a solid, comprehensive plan. He
vows to get more aggressive with pharmaceutical companies over drug
prices. And, if those prices still prove too high, to maintain the right
that countries like Thailand have to issue compulsory patents and
produce their own antiretrovirals.

The first move Giuliani should make, though, is to send Pipes back to
the sideline and hire some advisers whose values aren't predicated on
profit margins.

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