Paul Simmons Comments On the Future of HIV/AIDS Research
Paul Simmons: Director of treatment information and advocacy at The Center for AIDS in Houston
What's up with AIDS research? The same thing that's up with my hair -- thinning.
According to the Pharmaceutical Research and Manufacturers of America (PhRMA), the trade association for the pharmaceutical industry, 23 agents are under investigation for HIV infection. Five of them are "me too" drugs that add nothing important to the therapeutic arsenal, and another three have suspended development. Of the remaining 15, only eight are potentially novel or second generation agents, and some of them may not withstand further study.
In part, the success of combination treatment generally, and of the protease inhibitors specifically, has undermined our once potent sense of urgency to find new drugs for treating HIV. Since Americans with AIDS are no longer dropping like British cattle, we've grown complacent. But that's only half the story.
The damaging effect of some of our activism has created an environment hostile to new investment in HIV drug discovery. Nowadays we activists have taken to demanding that free-market pharmaceutical companies behave like social service agencies and give their products away at cost -- or less. The drug companies, we say, "have blood on their hands;" they are "killing people with AIDS;" they are making "obscene profits." Our rhetoric is belligerent, even hysterical, and it is not without consequence.
Don't misunderstand me. The drug companies are out for money. In pursuit of the dollar, they sometimes misrepresent data, buy off our doctors, and exploit people. But those same companies -- through risk-taking fueled by the allure of profit -- also save lives, including yours and mine.
Except for long-term non-progressors and a few others, we adults in the U.S. living with HIV today are in a fix of our own making. When I seroconverted in 1996, I wasn't the victim of Ronald Reagan or Merck or the military industrial complex. I was the victim of my own inexplicable stupidity. No, I didn't want HIV, nor did I deserve it. Whatever any of us did to contract the virus, we don't merit a death sentence. But only through tortured logic could I now demand that pharmaceutical shareholders rescue me -- at their expense -- from the consequences of my own choices.
If you agree that the poor both at home and abroad should have the life-saving power of antiretroviral therapy, I say bully for you. But talk to our government, which is, by the way, the largest purchaser of anti-HIV drugs. The government, and not private industry, is responsible for public policy. And talk also to the governments in Africa, many of which are so corrupt and inefficient that they can't control dysentery much less HIV. (To this day, South Africa has yet to declare the HIV epidemic a national emergency.) But it makes about as much sense to insist that drug companies not profit from our disease as it would to insist that the farmer not profit from our hunger.
And yet, the steady assault on for-profit drug research is likely to continue, and grow even shriller. Reason is often subordinate to emotion. Sometimes the actual consequences of an idea don't matter to us. What matters are the good intentions that inform our ideas and the good feelings we get from them. We see ourselves in high archetypical battle with the evil capitalists, and we revel in the emotional satisfaction of moral arrogance.
Unfortunately, you may be the one to pay for our conceit. Industry will offer an ever-shrinking arsenal of new anti-HIV drugs, as it turns its attention to other, less troublesome areas. As one company executive said, "We can make just as much money doing other things and with a lot less hassle." We activists are haranguing the industry out of AIDS research.
A few years from now, your anti-HIV drugs will exhaust their benefit. But instead of finding something new to help you, industry will busy itself developing the next round of treatment for small breasts and impotence. If it's any comfort, as you lay in a hospital bed with tubes coming from every orifice, we activists will organize an angry demonstration on the sidewalk below. But there will be no new HIV treatment for us to demand, only free breast enlargements and free erections.
This article was provided by AIDS Community Research Initiative of America. It is a part of the publication CRIA Update. Visit ACRIA's website to find out more about their activities, publications and services.