It's unclear how significant this announcement really is. In sub-Saharan Africa, notes reporter Tove Iren S. Gerhardsen, there may only be four or five companies with the capability to take advantage of Roche's technical assistance. But in the light of the vigorous discussion that accompanied How the World Works' look at Brazil's confrontation with Big Pharma over AIDS drug prices, the news gives me the opportunity to try to add a little subtlety to the topic of intellectual property and the pharmaceutical industry.
Subtlety is hard. It's always irritating, though by no means surprising, to see how in the comments, one side or the other's arguments are always presented in what I'll call "the extreme voice." So, for example, I'm either an information revolutionary who believes that patents are evil and all intellectual property should be free to all comers, or I'm a ruthless free-market free trader who maintains that there will be no progress whatsoever unless corporations are allowed to own, for perpetuity, all rights to everything that was produced on their own dime.
Neither, obviously, is true. My own understanding of intellectual property law is that ideally, the goal of the courts and legislators who make and interpret the laws is to find the the proper balance between strong IP laws and the welfare of society. It seems pretty obvious to me that over the past couple of decades, corporations have hijacked the system and have swung the balance way over to their side. It also seems obvious to me that in the arena of public health, where lives are at stake every day, finding the right balance, and pushing back against corporate influence, is vital. And there really could be no better petri dish in which to examine that issue than in the plague of AIDS in Africa.
Getting Big Pharma to address the problem of AIDS in Africa, as well as many other diseases prevalent there, is hard for a very simple reason. There is no market. No one can afford to pay. So, one has to ask, what's the point of pushing these countries to respect patent protection, and prevent them from seeking generic versions of expensive drugs from other nations? It's not as if you are going to lose potential sales. And if you don't like Brazil or India cutting you out of the African market with cheap generics, make your own!
Intriguingly, the Final Report of the Commission on Intellectual Property Rights, an initiative of the U.K. government, noted in its chapter on health, after asking the question of "What role does IP protection play in stimulating R&D on diseases prevalent in developing countries?" that "All the evidence we have examined suggests that it hardly plays any role at all, except for those diseases where there is a large market in the developed world (for example, diabetes or heart disease)."
"The heart of the problem is the lack of market demand sufficient to induce the private sector to commit resources to R&D. Therefore, we believe that presence or absence of IP protection in developing countries is of at best secondary importance in generating incentives for research directed to diseases prevalent in developing countries."
So much for the argument that without strong IP laws, the drug companies won't make new drugs. They won't make them anyway if there's no one to buy them. But as a society it is in our interest for those drugs to be made. So how do you generate the proper incentives? Well, one way is to put enough public and government pressure on the private sector, so that it does the right thing. One way is to say, hey, we'll break your patent, or reduce its length, if you don't make more of an effort to take care of sick people who can't pay. This may depress profits somewhat; hell, it may even drive a weaker company out of business. So what? In the balance between social justice and profit, it's my belief that there's room to push the Roches and Mercks and Abbots in the world a little more in the direction of public health. It's simply amazing what is possible when the right amount of pressure is applied.
No one can say at this point whether Roche's gesture in regard to generics is a pure P.R. move without substance or will really result in cheaper AIDS drugs in Africa. But one guesses that the announcement would never have been made if there wasn't substantial pressure, both from the public at large and from the governments of developing countries, for justice.
Whew. That's my rant for today.