The price is right

April 28th, 2007 by Ben Goldacre in bad science | 41 Comments »

Ben Goldacre
Saturday April 28, 2007
The Guardian

In the west we breathlessly report on new breakthroughs in science, but it’s easy to forget that ideas are bought, rented and sold, as surely as deckchairs. Last week the academic blogger Shelley Batts received threats of legal action from academic publisher Wiley, simply for using a diagram on her blog, in a discussion about a foolish news story, which was based on an academic article published in a Wiley journal.

But the big unreported intellectual property issue from science this week is in Thailand, where there are more than half a million people living with HIV, and 120,000 have Aids, requiring treatment. First-line Aids drugs are becoming ineffective, as the virus becomes resistant, and so people need the expensive new drugs like Kaletra, made by the US drug company Abbott.

Fighting HIV with drugs is an incredibly clever field. Some work by blocking the molecular machinery that produces virus DNA. Kaletra is a “protease inhibitor“, and it works by blocking the activity of an enzyme called protease which cleaves proteins into smaller chunks which can then be assembled into a functioning HIV virus.

Abbott has been charging $2,200 (£1,100) a year for Kaletra in Thailand, which is – by macabre coincidence – roughly the same as the gross income per capita. I am no economist, but it seems to me that if you charge people’s entire annual income for a drug like that, then your customers will die.

Don’t pharmaceutical companies need to charge high fees, to recoup their research costs, and develop new ideas? Yes, they do, so let’s be fair. And if we’re going to be really fair, we might also mention that they spend twice as much on administration and advertising as they do on research.

So in January the Thai government put their hands up and announced they were going to use Abbott’s idea, and make Abbott’s drug, only for the country’s poor, in their own factories, to save lives. Abbott has retaliated by completely withdrawing its new heat-stable version of Kaletra from the Thai market and withdrawing six other new drugs from the country for good measure. It has refused to bring its products back to the Thai market until the government promises not to use a “compulsory license” on its drug ideas. To some this might seem on a par with taking hostages (or making them say sorry “like they mean it”).

In fact, the Thai government has a good history of forcing the drug companies to release their wares at more realistic prices and, interestingly, it has broken no laws. The 2001 Doha declaration made it clear that governments should put public health before companies’ patent rights, and under the TRIPS agreement from the WTO, governments can sign up to respect a patent, with the caveat that they can make the drug themselves, or import a generic version, in a national emergency.

So the US, for example, announced its intention to import generic Ciprofloxacin following the anthrax panic, sidestepping the patent on that drug, in the name of practicality in a crisis. The US terrorist anthrax epidemic killed six people, which says a lot about how the definition of national emergency can shift depending on who is dying.
But the fact that we feel entitled to be outraged at Abbott is almost more interesting than the question of intellectual property: because for some reason, we expect higher standards of the people and companies involved in healthcare, when in reality, this is just one of the many everyday ways in which we screw the developing world.

The World Health Organisation estimates that half of HIV transmissions in Thailand come from contact between sex workers and their clients. There are said to be 2 million women and 800,000 children under 18 working in the sex trade, and much of this trade is servicing western men. It doesn’t spread itself, you know.

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41 Responses

  1. Nellie Dean said,

    April 28, 2007 at 6:13 am

    The problem with supplying – or producing – cheap drugs for poor countries is that a huge proportion are intercepted by crooked middle-men and exported (or re-exported) to the West. Result: the third-world poor continue to die while corruption flourishes.

  2. Evil Kao Chiu said,

    April 28, 2007 at 11:09 am

    Isn’t the answer this?

    1. Drug manufacturers are companies. They operate for profit (technically and legally to maximise their owners/shareholders value) and are legally prohibitted by their A&M of association from doing anything else. To expect them to be charities is, as Ben points out, inconsistent with our expectations and their lgal duties.

    2. Governments and charities are not run for profit. Their aims are, generally, to do ‘good’ stuff. We the people provide their funds for this ‘good’ stuff.

    3. Therefore, if we want ‘good’ stuff done, we should look to organizations whose very existence is for the purpose of doing good and not expect, perversely, those organizations which we have established as explicitly non-charitable to behave as charities.

    4. In other words, governments – ours if we feel strong enough about it and I certainly do – should be subsidizing or paying for these drugs to be provided to places that cannot afford it. Charities may do likewise if citizens who really care rather than just wanting to jump on the currently trendy anti-‘Big Pharma’ bandwagon are willing to dip their own hands into their pockets.

    It seems relatively simple to me. The current position of saying – in effect – ‘My god, look at that profit-making company – it’s trying to make a profit! How disgusting!’ and then doing bugger all ourselves as we sit on Exmouth Market sipping our Vietnamese non-corporate coffee at two quid a cup while expecting only a discrete section of society to pay to remedy the mess is just hypocritical.

    Third world health is a public good. The public should pay.

  3. kayman1uk said,

    April 28, 2007 at 11:18 am

    Ben, there’s a fault with your website; I keep getting an article containing almost no science at all.

    Oh, well. At least I don’t need to buy Private Eye this month.

  4. Ahruman said,

    April 28, 2007 at 11:39 am

    Evil Kao Chiu, that is indeed one answer. However, it still leaves the pharma companies with a monopoly they can use to raise prices even further for the governments doing the subsidizing.

    A much simpler way is for governments to finance all the research on grants. Medicine patents would no longer be meaningful – they exist to allow an inventor to recoup their costs, but governments aren’t in it for the money – so they could be removed from the equation; production would then be a free market.

    Since governments already cover a large portion of that cost directly, and more than cover the rest by subsidizing expensive monopoly drugs for their own citizens, so this could actually reduce costs for western governments.

  5. imagineyoung said,

    April 28, 2007 at 11:42 am

    Bloody hell, you’re expecting people to take personal responsibility now. You’re going to be very unpopular.
    Last paragraph was a real kicker.

  6. SciencePunk said,

    April 28, 2007 at 12:10 pm

    interesting stuff.

  7. Mithent said,

    April 28, 2007 at 12:31 pm

    Certainly, the drug companies have to make a profit, but how is selling drugs at prices that no-one can afford in a particular company beneficial to that? Charging the average GDP per capita for a drug is going to result in virtually no sales; if they sold it at a price that was acceptable to many, they’d get hundreds of thousands. I guess they’re worried about it making its way back to wealthier countries, though that’s no new problem to drug companies, especially if generics are being produced.

  8. censored said,

    April 28, 2007 at 12:44 pm

    With most products, the price is set according to the market. That’s why a car in Europe is cheaper than in the UK, or a Playstation is cheaper in Japan.

    Why can’t the drug companies do this? Set the price according to what a territory can pay. At the moment, their sales in Thailand are £0. If they sold the drug at 1p per pill, their sales would be £100,000.

    Obviously there’d be a smuggling problem with cheap drugs diverted, but that’s already illegal and happening – it would need stricter enforcement and severe penalties. Not because I feel sorry for big pharma, but so a reasonable price scheme for all can be implemented.

  9. Deano said,

    April 28, 2007 at 1:08 pm

    Lets not forget those guys who are in denial about HIV and AIDS who also screw the third world in the name of profit.

    But not it seems in Australia where they have had a bit of a setback:

  10. ChrisR said,

    April 28, 2007 at 1:42 pm

    The Thai defence and “public order” budgets have together increased by more than $1bn this year (

    Pity they didn’t spend that money on AIDS drugs.

  11. Ben Goldacre said,

    April 28, 2007 at 2:44 pm

    Ben, there’s a fault with your website; I keep getting an article containing almost no science at all.

    i think that’s a completely legitimate criticism. this week i could have done lots of things:

    some stupid drugs stats which steve covered very well at tdpf

    or the indy on sunday’s electrosensitivity front page which is a farce.

    but those are issues i’ve already covered in the past year.

    there are a couple of other bigger stories from recent news events which i’m working up, but they will time to shake down into an unambiguous denouement (muhahahah etc).

    with this thai thing, i think intellectual property is an incredibly important issue, i think it’s an important backdrop to a lot of scientific issues, and i think it’s something that is overlooked and misunderstood. i also think the fact that people fantasise that healthcare companies have special rights and responsibilities beyond normal corporations is very interesting.

    i sat and watched assuming somebody else would write about this subject this month, since it has been bubbling for weeks, with the shareholders meeting this weekend as a bit of an event horizon, and was horrifed and amazed to see nobody write anything about it anywhere, so i dashed it off and bunged it in.

    that’s not a self justificatory thing, just an explanation. gotta keep moving and all that.

    also it’s a bit dry because the paper made me rewrite on grounds of obscenity and tastelessness when i was slightly short of time.

    just for your interest, this is how the original version of this piece opened:

    How do you make intellectual property into a sexy issue? It has been estimated that there are 2.8 million sex workers in Thailand: two million women, and 800,000 children under the age of 18. If each is the unlucky recipient of 3mL of sperm, on average, per day, from a fat ugly western man, then that’s 9,000 litres of sperm a day, or 60 beer barrels, or 20,000 barrels of sperm a year, which would take a fleet of 100 oil tanker lorries to deliver by road.

    How is this relevant to intellectual property? Bear with me. The World Health Organisation estimates that 49% of HIV transmissions in Thailand come from contact between sex workers and their clients. There are half a million people with HIV in Thailand, where 120,000 have Aids and need treatment. First line Aids drugs are becoming ineffective, and so they need the expensive new ones like Kaletra, made by the US drug company Abbott.

  12. censored said,

    April 28, 2007 at 2:57 pm

    Ha ha… love it!

    I think you should amend the blog accordingly…

  13. Gimpy said,

    April 28, 2007 at 3:16 pm

    11. “from a fat ugly western man”

    I hope you have a peer reviewed source for the claim that western users of Thai prostitutes are fat and ugly.

    Anyway, it’s worth pointing out that some big pharmaceuticals have waived royalty payments on some HIV/AIDS drugs.
    I don’t know if this strategy comes out of a genuine concern for public health or a pragmatic approach to the futility of trying to stop generic drug production. Its worth pointing out anyway.

  14. profnick said,

    April 28, 2007 at 4:02 pm

    “from a fat ugly western man”
    I should think he’s thin and ugly by now; he must be well knackered!

  15. misterk said,

    April 28, 2007 at 5:24 pm

    Uh, on a viewing front, when I expanded this entry the text fell all the way to the bottom of the page, so half the comments were in the big black sidebars, and thus difficult to read.

    On an ethical note, I am about to study an Msc in Medical Statistics, and will more than likely go into this kind of research- the question? Go where the jobs are (i.e. big pharma) or the handful of independent research? Ah dilemmas….

  16. j said,

    April 28, 2007 at 5:28 pm

    “It has been estimated that there are 2.8 million sex workers in Thailand: two million women, and 800,000 children under the age of 18”

    Isn’t your maths out here? There’s also adult male sex workers in Thailand (e.g. see p55-60 of this SOROS report –

    Anyway, one other issue. In terms of people getting screwed (literally and figuratively) one can argue that the Thai government, and parts of the Thai business community, have both allowed a large sex work industry to develop and have profited from its development. Maybe it’s better to talk about international (Western and non-Western) elites screwing others, rather than the developing world getting screwed?

  17. Robert Carnegie said,

    April 29, 2007 at 1:33 am

    The people who send me unsolicited pictures of themselves with their Thai sex worker friends, typically are iat ugly Western men, and the sex workers appear to be female. Thailand is Thailand (and they’ll hate my saying so) but in these cases I’m very close to certain.

    I was going to propose that the problem with governments funding healthcare research instead of business doing it is that poor countries’ governments don’t have the spare cash, but the defence budget is suggestive. But then if they don’t pay for defence then they’re buggered -that- way. And, really, how much money will it take to treat AIDS in that country, long term? And how many fat ugly Western men will pay the price themselves? Maybe that’s the only hope.

  18. Deano said,

    April 29, 2007 at 4:14 am

    I don’t think that Ben’s article “contains no science” is a legitimate criticism at all.

    Although I applaud Ben for responding to it even if he was tired…

  19. Skeptyk said,

    April 29, 2007 at 4:15 pm

    “…says a lot about how the definition of national emergency can shift depending on who is dying.”

    Good point. In the case of the WTO exemptions (for governments to make or export a cheaper version of a patented drug in the face of emergency), I hope that it is left just that vague, so the nations themselves can decide what is and is not an emergency. To have rules specifying criteria will just delay real medical actions while legal wheels grind as each side prepares its case to bring to WTO tribunals.

    Of course preplanning to PREVENT, or/and to be able to respond quickly to, these crises would be better, and cheaper, but where’s the money in that?

    Health care has not been – and, I would argue, cannot be – provided on typical capitalist market models, despite libertarian fantasies. And that’s okay. Alas, I live in the US where we have no NHS and haphazard incentives or laws to ensure commercial health insurance (which is notoriously topheavy).

  20. Skeptyk said,

    April 29, 2007 at 9:37 pm

    Ben: “…it is odd how people have an idea that healthcare co’s should behave uniquely well.”

    Unreasonable, sure, but not odd. It is a nice scapegoat, BigPharma, for the anxieties we may feel at not doing more. As individual citizens we do not have the means to take care of much suffering, yet we know there is a lot of suffering out there. We can alleviate some of our empathetic pain by pointing at someone like BigPharma, who has lots of $$$, and say, hey, they could fix this mess if they were not so greedy.

    The fact that they ARE greedy, and that greed is actually the main legal obligation a corporation has to its owners, may be true, but it is not to the point here.

    BigPharma carries a considerable burden of its own “sins”, for sure, but we cannot legitimately get absolution for our sins by dumping them on that scapegoat, and doing so perversely “allows” us to do less, rather than more, to alleviate suffering.

  21. bootboy said,

    April 29, 2007 at 11:45 pm

    “BigPharma carries a considerable burden of its own “sins”, for sure, but we cannot legitimately get absolution for our sins by dumping them on that scapegoat, and doing so perversely “allows” us to do less, rather than more, to alleviate suffering.”

    That’s very morally confused. If we think that there is a problem with big pharma, we are not alleviated of our responsibilities or guilt – we are presented with a means of absolving our guilt – by making sure that the problem goes away, i.e. by trying to stop big pharma doing the nasty stuff that it does. If we were to simply blame big pharma and do nothing about it, we’d be even more guilty that we were before we knew.

    And, as for the person who doesn’t think that intellectual property is a scientific issue – you obviously don’t have much familiarity with the issues that one faces as a working scientist – it’s a huge, bothersome, enormous waste of time and resources that you have to deal with all the time and scientists are probably the only people who aren’t entirely co-opted who are in a position to speak about it from experience.

    Personally, I think the very notion of intellectual property is morally repugnant. Every single little advance in science or human understanding or human creativity is built upon an almost infinite set of incremental enabling innovations. To plunder human intellectual history, plant a miniscule cherry on top and build a toll-bridge around it is just grand larceny in my book.

    And if your economic model can’t accomodate this basic moral requirement, there’s a problem with your economic model.

  22. Skeptyk said,

    April 30, 2007 at 1:19 am

    Sorry if I was not clear, bootboy. Read it again, because I think we agree. I was trying to imply that just grousing about BigPharma, as if we are helpless in the face of its bigness, is ALL most folks do, and that is not enough.

    Scapegoating means placing the burdens of one’s own sins onto another, thereby absolving one of guilt. That is why such scapegoating is doubleplusungood.

    BigPharma has plenty that they are guilty of, and we must point that out. We do not get off the hook for our own ethical failures, as individuals or as the citizens of a nation or a world, by doing no more than that, however. The point of scapegoating is to feel better about yourself. In this case, it is to relieve the moral dissonance one feels about being safe and unmaimed though faced with the suffering of another(s).

    That is why I wrote that this psychological mechanism perversely “allows” us to do less. That is why allows is in those little quotation marks. To imply that such allowance is bogus.

    If scapegoating “works”, then we do not have the same psychological pressure, the same discomfort, if we tell ourselves that others are at fault. Indeed others ARE at fault, AND we are morally responsible to try to hold those others accountable, “i.e. by trying to stop big pharma doing the nasty stuff that it does”

    The same psychological mechanism is at work, IMO, among conspiracy theorists, such as the HIV denialists, and Intelligent Design fans. As long as they are caught in the hall of mirrors, they can assure themselves that they are doing great deeds.

    I am pretty much with you on the “intellectual property” issue. Standing on the shoulders of everyone else is simply human.

    As an artist, and as a health care worker, I wish I could just receive some standard living stipend and be supported with the means to do those vocations well, rather than have to compete in some marketplace, selling my art and my labor. Within the present system, I am supposed to protect and copyright my art lest someone else earn from the sweat of my pen. The whole set-up sucks.

  23. Skeptyk said,

    April 30, 2007 at 1:21 am

    Cheesh, I really fumble this html. As you can guess, most of those italics up there are not intentional, but y’all get my drift?

  24. outeast said,

    April 30, 2007 at 11:01 am

    Hey, I’m having the trouble with the position of the text too (on some other posts here too). I’m pretty sure it’s because of the long URLs people keep putting in comments – any chance they could get replaced with TinyURLs or something?

  25. ChrisR said,

    April 30, 2007 at 11:35 am

    The danger with the debate is that it sometimes gets reduced to a simple mantra of “public good, private bad”. However this is not the answer.

    Arguably the biggest UK medical scandal of recent times was the infection of people with haemophilia with HIV and Hep C from contaminated blood products provided by the NHS.

    Some of the responsibility for that disaster must be laid at the door of the Blood Products Laboratory: this was, and still is, a Government owned facility. There is no private money in it, no private management, no profit motive. And yet things still went wrong.

    Consider if, despite that experience, the Govt. did establish a state-owned “British Pharma”, can you imagine a minister who had to announce that despite spending £500m (or whatever huge number is actually required) of tax-payers’ money on getting a drug approved it had failed? The outcry would be enormous – and there would be intense pressure for the minister to go. That kind of outcome creates incentives for the state owned company not to fail – which may be similar too, or possibly even stronger than, commercial companies’ incentives to get drugs to market no matter what.

    Rather than grand sweeping attacks on “Big Pharma”, a more measured approach is required. Setting acceptable rates of return – which adequately reward shareholders for the risk they bear – is a better way to ensure that pharma companies earn their just reward from their IP but don’t make windfall profits. Of course, doing that in practice is fiendishly difficult …

  26. malcolm said,

    April 30, 2007 at 12:04 pm

    re moral confusion. This year is the 200th anniversary of the UK government bill for abolition of the slave trade. I live in the town where John Newton wrote Amazing Grace and this weekend we had a celebration of his role as a former slave trader turned abolitionist.

    One of our preachers was from Sierra Leone and he made a challenging point which relates to this debate – discussing reparations for the slave trade he likened them to medieval indulgencies sold to the rich to get them into heaven (whatever that means). The only true reparation for a trade which underpinned the industrial revolution and our own prosperity is to walk with the African people in fighting injustice.

    It is our moral duty to help Africa and Asia overcome aids by providing cheap (free) retrovirals etc.

    On the commercial market point, all market solutions for the problems created my markets fall foul of Einstein’s dictum – problems cannot be solved by the thinking which created them.

  27. Elmwood said,

    April 30, 2007 at 2:03 pm

    While I dislike the idea of intellectual property for the same reasons as bootboy (post 12), I think the people posting about “scapegoating” have a point too, and as such I would be really interested to know what people like us in the rich world can actually do on an individual basis. Seriously, I’m not being rhetorical – I know I probably sound naive but for example Evil Kao Chiu said “…governments – ours if we feel strong enough about it and I certainly do – should be subsidizing or paying for these drugs to be provided to places that cannot afford it. Charities may do likewise if citizens who really care rather than just wanting to jump on the currently trendy anti-’Big Pharma’ bandwagon are willing to dip their own hands into their pockets…” – do you have any examples of schemes or organisations that are already up and running that people can get involved in?

  28. BrickWall said,

    April 30, 2007 at 3:28 pm

    Is it just me or is there something skewed here? The whole of this article and comments appear to the left of the screen below the other links?
    None of the other articles do this? How can I read this properly any suggestions? (Of course I won’t be able to read the first 2 inches on the left of any reply!!!

  29. Teek said,

    April 30, 2007 at 4:12 pm

    big pharma is collectively the most rutheless, profit-driven, unquestionably corrupt and disproportionately powerful group of companies on earth. they exploit three major factors that almost all humans have in common:

    we all fall ill.

    we all want drugs to make us better.

    we will do anyting it takes (or possible anything we’re told it will take) to get the drugs.

    the unethical standards seen in the pharmaceutical industry are dispicable, but i feel Ben’s right with his point that unless we legislate for state involvment, we are culpable in terms of allowing the corporate interests to steam roller human rights and science.

    the whole industry stinks, which is a shame as they undoubtedly do some good in many quarters – its just that the bad stuff that goes on (read the body hunters by sonia shah) outstrips any good by factors of millions imho.

  30. BrickWall said,

    April 30, 2007 at 4:36 pm

    Sorry to bang on about this but I think it is being caused by the long link provided in posts 9, 10 and 15 as the screen tries to centre them across the middle block. But surely this must be affecting other people? Is there something I can do on my browser to stop this?

  31. Deano said,

    April 30, 2007 at 9:10 pm

    Apologies for the long link I’ll tinyurl next time!

  32. pv said,

    May 1, 2007 at 12:09 am

    Teek, do you really think the pharmaceutical industry hurts more people than it helps (speaking of the “bad” outweighing the “good”)?

    What do you think of the ruthlessness of Banks, by comparison, and the “good” they don’t do given how much profit they make/steal? Personally I’d put Banks and a few others way above the pharmaceutical industry when it comes to profitability and taking advantage.

  33. pv said,

    May 1, 2007 at 12:13 am

    BrickWall, (post 31) what browser are you using. I’m using SeaMonkey and it all looks ok to me. The links you refer to have been split so they don’t work properly unless you cut and paste them.
    Have just looked at it in IE7 too, and it’s the same there.

  34. BrickWall said,

    May 1, 2007 at 9:57 am

    Thanks seems to be resolved. Now I need to read article in between nappy changes!

  35. wewillfixit said,

    May 1, 2007 at 10:34 am

    Wow, reading the Bad Science blog when you are still in nappies? You must be a child progeny!

  36. FlammableFlower said,

    May 1, 2007 at 1:51 pm

    The fact they spend so much on admin and ads versus research really rankles – and now the the big pharma companies seem to spend their time buying up smaller firms because they don’t have enough products in the pipeline… Why? Oh, that’ll be because you haven’t spent enough on research…

  37. BrickWall said,

    May 2, 2007 at 11:33 am

    OK now viewing againfrom work computer and its all gone skew whiff again. Must be something to do with work settings (which I’ve just noticed is IE6 not IE7 which looked fine at home). Maybe someone here trying to stop me viewing bad science when I should be working – I’d argue its background research though!
    Weird that its just this article though?

  38. wewillfixit said,

    May 3, 2007 at 8:47 am

    Nekomatic – it was deliberate (stolen from Calvin and Hobbes).

  39. Crispy Duck said,

    May 3, 2007 at 4:58 pm

    Re: the formatting issues – to anyone who, like me, is unable to use a different (ie > IE6) browser, just press Ctrl-A to select all the text on the page. It’s a bit ugly but you will at least be able to read the comments.

    On topic, I work for a company which has recently (ie last week) obtained FDA approval for a novel HIV treatment. Of course they’re out to make money, but they have also developed a treatment that will make a real difference to a lot of people.

  40. hatebad said,

    May 20, 2007 at 11:14 pm

    Why moan about the profits made by big Western pharma companies and pass that business to smaller pharma companies in India and Thailand. These companies are no more ethical than the big pharma companies and just as willing to make a profit.

    Ironically, some of these companies complain about big pharma patents but file their own patents in their own markets. Take a look at Cipla.

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