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Gordon Nary

November, 1996

With the advent of our learning how to use combination antiviral therapies more effectively, we have ushered in a new wave of AIDS activism that is blaming pharmaceutical manufacturers for the lack of access to AIDS drugs by 96 percent of the world population with HIV disease. There is a new Star Wars mentality that positions the pharmaceutical industry as the "Evil Empire." And the HIVIPs of the Republic have girded their loins in Calvin Klein righteousness and unsheathed their light sabres to wage battle for the noble cause.

The pharmaceutical industry is an easy target. Just the term conjures up Gordon Gekko-like CEOs shouting "Greed is good." And demonstrations by "victimized" people with AIDS--with the accompanying circus of righteous anger, faux blood-spattered researchers, and men on roller skates dressed as nuns--are gleefully taken up by our mass media, ever looking for telegenic scenes.

While the pharmaceutical industry can and should do more to help address what may be the most fundamental challenge to our society, the responsibility for public health is primarily the government's. Where governments lack resources to provide drugs and other medical services, the responsibility to help is governed by the ethical value of beneficence, which challenges all of us. And while the pharmaceutical manufacturers may have special ethical challenges for fair pricing of life-saving drugs, they must also balance that obligation with their obligation to their stockholders without which there would be no funds for drug development.

Unfortunately, we have no national or global ethical guidelines to help us address fundamental questions such as how we can provide the available vaccines and medicines to eradicate the variety of preventable and treatable infectious diseases that claim several million children's lives each year. Until we successfully respond to this challenge, we will not be able to address how we need to ration the limited supply of expensive, life-saving and life-extending drugs for HIV disease.

Now for a challenging ethics lesson. Some last-minute maneuvering between a few AIDS activists and Congress resulted in a loss of $50 million originally allocated to the AIDS Drug Assistance Program (ADAP). This money was to be used by local community boards exclusively for AIDS drugs for the poor. Instead, the $50 million was transferred to five Ryan White Title funds. Now, while some of the $50 million in the Ryan White transfer will be allocated for AIDS drugs and viral load monitoring, much of it will be used for AIDS-agency salaries and quality of life services to preserve the status quo.

The net result: people in Los Angeles, San Francisco, and New York will continue to have a wide variety of valuable psychosocial services. And many of the well-paid AIDS-agency staffers can keep their jobs. But it will be at the expense of the lives of mostly poor and mostly black men and women in Alabama, Mississippi, Arkansas, and other resource-limited states where the original ADAP monies were the only resource for AIDS drugs. When AIDS drugs or the funds to purchase them are limited, those who benefit from the allocation do so at the expense--and in this case, the death--ofthose who lose.

If I were a socially conscious pharmaceutical executive, I might be tempted to demonstrate in front of some of the AIDS agencies that maneuvered the ADAP gutting.

©1996, Medical Publications Corporation

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