doi:10.1136/bmj.326.7402.1296 
 2003;326;1296- BMJ
  
Nathan Ford 
  
 Public health and company wealth
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DEVELOPING WORLD
1296
BMJ VOLUME 326  14 JUNE  bmj.com
T
he doctor’s role goes from care
giver to undertaker. You talk to
them about the cheapest method
of burial. Telling them about the
drugs is always kind of a cruel
joke,” said Dr Chris Ouma of
Kenya, where 2.5 million people
are infected with HIV, and most
cannot afford AIDS drugs. His comment reflects the
difficult relationship between patient and doctor in the
developing world, where millions are dying because
they cannot access the medicines they need. 
This issue made international headlines during the
World Trade Organisation’s Seattle meeting in
December 1999. The high price of AIDS drugs
became a banner of the world’s iniquities: on one
side of the globe, Western multinationals made
billions of dollars; on the other side, millions of
people died from treatable infectious diseases.
The pharmaceutical industry has responded to
growing criticism by reducing some drug prices for
some countries. But few patients in developing
countries are aware of these efforts. Progress in
reducing drug prices has depended mostly on market
competition and media attention.
Three years ago AIDS treatment cost $15 000 a
year whether you lived in London or Lusaka. Today,
some pharmaceutical companies provide discounts
for sub-Saharan Africa. This is clearly good, but
companies are not doing all they can. At the
beginning of 2003, while one company was claiming
that “the pace is picking up” in providing
antiretrovirals to poor countries, another was
charging $2000 a year more for its AIDS drug in
Guatemala than in Switzerland.
The responsibility to ensure access to essential
medicines lies with governments. In 1996, the
Brazilian government began to provide AIDS
treatment for all in need by making their own version
of expensive brand drugs, reducing costs by around
80%. Over 115 000 people in Brazil now receive
antiretroviral treatment. But few have been able to
follow Brazil’s example. 
Because market prospects, not health needs, drive
production lines, drugs are developed for Western
diseases while diseases of the developing world are
ignored. In many clinics, doctors are forced to use
old drugs that are toxic and don’t work well. For
some diseases, no medicine is available at all. Buruli
ulcer, a disfiguring and debilitating infectious disease,
is a good candidate for antibiotic treatment, but
because no drugs have been developed the only
option is surgery, including amputation. 
Better business behaviour
A group of major UK investors recently published a
report urging drug companies to improve poor
people’s access to medicines. The report proposed a
framework of good practice to audit companies’
behaviour on issues like anti-monopoly enforcement,
fair pricing and unfair use of political influence.
The response of the Association of the British
Pharmaceutical Industry to the concerned
shareholders was: “The problem is not the attitude or
commitment of the pharmaceutical industry. It is one
of poverty, lack of infrastructure, and lack of political
will.” Everyone’s fault, in other words, but not the
industry’s. And yet the drugs industry can do much to
contribute by reducing prices systematically for poor
countries and directing some of its enormous drug
development capabilities to neglected health needs.
An international convention should be developed
to ensure that new medicines are developed according
to global health needs, and equitable drug pricing
should be ensured through a mandatory framework.
Patients are not consumers: they cannot choose
between AIDS and leukaemia, and few can move
from Guatemala to Switzerland. While medicines are
treated like luxury consumer products, millions in
poor countries will continue to go without the
lifesaving medicines they need, and doctors will
continue to play the role of undertaker, advising on
funeral costs because it is the only option available. 
Nathan Ford access to medicines adviser,
Médecins Sans Frontières, London EC1N 8QX.
nathan.ford@london.msf.org
Public health and company wealth
When public protest at the price of AIDS drugs reached a peak, pharmaceutical companies
seemed to take note, but the developing world’s health problems will never really be tackled as
long as remedies for Western afflictions remain more profitable, writes Nathan Ford
Bono and Bob Geldof urged Tony Blair to unite world leaders in the battle
against AIDS when they met for a “Breakfast for Africa” last month
“
HUGO PHILPOT/REUTERS 2003
 on 14 May 2007 bmj.comDownloaded from