Patents versus patients

Healthcare has seen far-reaching changes over the years, and people are living longer, healthier lives than before. Yet, according to the World Bank and the World Health Organization (WHO), there are more than 1 billion who still have no access to health services and modern medicine.

Burning questions: Fire in the Blood examines the controversial but crucial issue of accessible AIDS medication

This is the problem which has been tackled by filmmaker Dylan Mohan Gray, in his 87-minute documentary Fire in the Blood. The documentary records how a group of dedicated men and women across four continents worked and campaigned to force the world's major pharmaceutical giants to make antiretrovirals (ARVs) available as generic drugs to people with HIV and AIDS the world over.

Dr I S Gilada

Described on the movie's official website as ‘an intricate tale of medicine, monopoly and malice', the documentary traces health crisis in countries of Africa and global south in the years after 1996 -- when Western pharmaceutical companies blocked access to low-cost AIDS drugs -- causing ten million unnecessary deaths.

Fired with enthusiasm: Director Dylan Mohan Gray says the inaccessibility of AIDS medicine has caused more deaths than the Holocaust. Pic/Satyajit Desai

Outrage
At a recent open discussion about the film at the True School of Music in Lower Parel, director Gray said, "The thing that really attracted me to make the film was a sense of outrage towards the issue. Also the characters in the film are really remarkable people. We as filmmakers were ridiculed and laughed at. But the people in the film, they believed this could work.

"The number of people who died unnecessarily because of the blockade of AIDS drug in Africa was at least 10 million. Actually the number is higher. Individual lives and families have been devastated. Other than a few written articles, there is no comprehensive account of it either in books or films. Consider about how many books and films have been written about the Holocaust, this crisis comparatively killed double that number of people."

Attitudes
Gray further adds, "What surprised me was the attitude of people towards these pharmaceutical companies. They are publicly traded companies. They have to show profit every three quarters. If they don't show the profit, the employees bear the heat. It is not even a moral thing. It is literally, all about money. Everything else doesn't matter. After releasing the film in the states, we constantly had arguments that ‘don't you realize that these people have fiduciary responsibility to maximize their profits for their share holders'? To me that is unbelievable. That means they are legally required to maximize their profit. Which is all well and good, but at what cost? You can't say, ‘well we killed a few too many people this month.' I think that overrules your fiduciary responsibility."

Fight
President of Aids Society of India Dr I S Gilada says that in Africa and other poor countries, people once died "like flies". He says, "There is a current battle going on in the Delhi High Court for an anti-cancer drug called Dasatinib. One of the virals of the drug is from a company called Bristol-Myers Squibb (BMS). Now, one injection of this drug costs Rs 1,60,000. The Indian manufacturer, BDR Pharma, which has applied for the compulsory licence, has made the drug for Rs 8,000. In this amount that company is not doing charity and it is still making a profit. This could be a life-saver medicine for many patients. BDR Pharma's application seeking compulsory licence on this exorbitantly priced anti-cancer drug is still pending with the Patent Controller. This should not happen. We should respect patents but patents should not come in the way of saving patients."

Under a compulsory or mandatory licence, an individual or company seeking to use another's intellectual property can do so without seeking the rights holder's consent, and pays the rights holder a set fee for the licence.

Campaign
Following a campaign on affordable healthcare and medicines on the television programme Satyamev Jayate last year, some state governments have begun providing generic and low-cost medicines, but India still has a long way to go. Dr Samit Sharma, Managing Director of the Rajasthan Medical Services Corporation, who is a pioneer in the movement for affordable medicines, says, "According to the WHO, 65 per cent of the population still lack regular access to essential medicines, and over 23 per cent of the sick do not seek treatment because they do not have enough money to spend. In India 80 per cent of the money spent on health is private out-of-pocket expenditure."

Accessible
Dr Gilada however adds that common medicines in India are accessible. If a patient goes to a government hospital, they get everything free. "The only problem is for the newer patented medicines, for which the government has to be proactive," he says. "Our government should not be so gullible under the pressure of powerful countries like the US and not give compulsory licence for those newer patents. Companies end up having 93 per cent profits at the cost of the patient. We all would like to respect patents but lives of the people is more important than copyrights."

Difference
According to Dr Gilada, there are 30 lakh HIV+ patients in India reportedly. Of which, 60 per cent are men, 38 per cent women and 2 per cent children. In Mumbai, there 6,500 patients HIV+. According to Dr Gilada, thanks to low cost medicine, the number of HIV patients are considerably reducing. He says, "In 1994, I had approximately 500 HIV+ patients and in 2000 I had only 250 HIV+ patients. This shows that if people can afford the medicines and take them regularly, their lives can be saved."

Awareness
To facilitate consumer awareness, Gilada advises, "Chemists should provide the different brands available to the consumer, because the price of the drug also depends on the brand name. There is not much difference in the quality of the drug. Also there is a website called patientindia.com. Here, once you search for the drug you are looking for, you come across a list of brands and prices. It is more convenient than chemists putting up boards with the price details. Not everyone has the patience to do that."u00a0