[Ip-health] Guardian: Saving lives? It's patently obvious

[Ann-Marie Sevcsik]

http://www.guardian.co.uk/commentisfree/2009/sep/05/drug-patents-developing=
-world

Saving lives? It's patently obvious
Ben Goldacre
Saturday 5 September 2009 02.09 BST

How do patents affect science? This week in India, US drug company
Gilead lost its appeal to stop local companies making cheap copies of
its Aids drug Tenofovir. It is not alone: in 2007 Novartis lost a
lengthy case trying to force the Indian government into strengthening
its weak patent laws. India remains the free pharmacy of the world.

Cheap drugs may not be the only benefit of India's approach, but the
drugs are certainly cheap. The cost of Tenofovir in developed
countries is $5,700 (=A33,500) per patient per year: the Indian generic
version is available in the developing world for just $800.

Because of this price difference, 75% of the 4 million people in the
world taking medication for Aids are using generic copies. Almost all
of these are made in India, and about 40% of the world's Aids patients
are taking drugs made by one company: Cipla, which is now the biggest
manufacturer of antiretroviral drugs in the world. Ignoring patent and
licensing issues has allowed Dr Yusuf Hamied, director of Cipla, to
innovate. Even though each drug is officially owned by a different
company, he could put a common combination of three treatments
(Stavudine, Lamivudine and Nevirapine) into one simple, single
combination pill.

This increases treatment compliance =96 it's easier to take your
medication correctly =96 and that keeps you alive longer, while reducing
the emergence of resistant strains. Hamied calls his pill Triomune (he
also offers "Antiflu", a copy of Tamiflu for the developing world, and
many more). In 2001 he was selling it to M=E9decins sans Fronti=E8res
(MSF) clinics for $350 per person per year, more than 30 times cheaper
than the official versions of these drugs. Triomune is only $87 a
year. Hamied is a hero.

Richard Sykes, head of GlaxoSmith-Kline (and now rector of Imperial
College London) disagreed. He called Hamied a "pirate" and described
the quality of Indian generic drugs as "iffy". Hamied says GSK is a
"global serial killer" for charging high prices for its medication. So
who is right?

Drug patents are a fascinating trade-off between the benefit of
incentive, and the harm to innovation. It takes about $800m and 10
years to bring a drug to market: during this time you make no money,
and your drug could fail at any stage. As a sweetener, after this, you
have 10 years of being the sole manufacturer to recoup your costs and
make a profit. There are other benefits for all of us. Instead of
relying on obsessive secrecy to protect your idea (which is how Coca-
Cola protects its recipe) patents allow drug companies to safely
disclose more information in public, which helps other people
innovate. Protecting ideas also allows a smaller company to negotiate
outside investment and develop its theories.

But patents can also retard innovation. Even though your competitors
may have greater expertise in the relevant fields, they will be
hindered from doing research into derivatives of your drug, or other
uses for it, or improvements to it.

Thomas Edison managed to get a broad patent on his improvements to the
light bulb, and this forced his competitors =96 who had made subsequent
technical improvements of their own =96 out of business. It took a world
war to cajole the Wright brothers into finally agreeing licences for
everyone else over their patent on the aeroplane. The other downside
is the monopoly. With patents you are the sole provider of a drug, you
get to set the price in each country, and if your drug is lifesaving
then everyone has to pay it, or die. In many places, they just die.
There are 33 million people living with Aids in the world today. Two
million die every year, and at the moment, despite heroic improvements
in the last five years, 70% of those who need treatment do not get it.

Patents weren't devised out of a sense of natural justice. They are
there to incentivise innovation, to "add the fuel of interest to the
fire of genius", as Abraham Lincoln said. So how much fuel can you get
from the developing world? According to MSF, Africa, for example,
accounts for 1% of the world's medicine market. If the global $550bn
pharmaceutical industry is trying to make an economic case for patents
in the developing world, then it must argue that the benefit to drug
development from the financial incentives in these tiny corners of the
world market is so significant that it is more important than millions
of unnecessary deaths.

I am not a health economist, but I doubt that is a fair swap. This is
not what patent laws were invented for.

guardian.co.uk =A9 Guardian News and Media Limited 2009