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Perspective

March 17, 2001

AIDS Drugs and Africa: Profits vs. People
When Poor Nations Need Expensive Treatments

PRETORIA, South Africa (Zenit.org) - Should pharmaceutical companies cede their patents to help AIDS victims in Africa? Should the firms sell the drugs below cost?

Debate over these questions has intensified recently as activists, countries and drug firms grapple with the problem of how to make AIDS treatments accessible to people who normally could never afford them.

Pharmaceutical giant Bristol-Myers Squibb this week announced that it would no longer try to stop other companies in Africa from making generic versions of one of its drugs used to treat human immunodeficiency virus (HIV), the New York Times reported March 15. Bristol-Myers holds the patent on d4T, or stavudine, sold as Zerit, and said it would not use its legal rights to keep lower-cost generic versions of this drug out of South Africa or any other African nation.

Bristol-Myers also said it would slash the price of Zerit and another AIDS drug, ddI, or didanosine, sold as Videx, in Africa, to a combined price of $1 a day. In the United States, one day's dose of the two drugs costs $18.

The decision was praised by many activists who have been urging the drug companies to allow generic-drug makers to make cheap versions of lifesaving medicines. "This is groundbreaking," said Kate Kraus, a member of ACT UP Philadelphia, a group that has led protests around the world against the big drug makers.

Bristol-Myers' announcement came shortly after U.S.-based Merck & Co. decided it would offer Crixivan and Stocrin, its two anti-retroviral medicines, for $600 and $500, respectively, per patient per year in the developing world. "At these prices, it said, it would make no profit," the Financial Times reported March 7.

Property rights

The decision to reduce prices came just after a trial commenced in South Africa, brought by 39 pharmaceutical companies who are challenging a 1997 law giving the government power to produce or import cheaper versions of drugs still protected by patent. South African authorities say that with up to 4 million HIV-positive people in their country, the drug industry has not reacted sufficiently to help meet the high cost of treatment for infected patients. The companies, for their part, accuse South Africa of letting the AIDS problem get out of control.

Human rights groups say the case goes beyond legal matters, the Washington Post noted March 6. The deeper question, the groups say, is to what extent the property rights of prosperous Western corporations should prevail against the developing world's need to curb a major public health crisis. It's estimated that of the 36 million people living with HIV, more than 25 million are in sub-Saharan Africa.

The pharmaceutical debate is not limited to AIDS treatments. The Guardian newspaper in England reported Feb. 12 that sufferers of diarrhea, meningitis, malaria and tuberculosis also go untreated because the drugs they need are too expensive for them.

The cost of treatment for HIV is particularly high. AZT and 3TC, the basic anti-retroviral drugs, carry an annual price tag of $10,000 to $15,000 per patient. By contrast, most workers in South Africa earn less than $3,000 a year -- and they are considered rich by the continent's standards.

Brazil, India and Thailand have started producing cheaper versions of anti-HIV drugs. Cipla, an Indian firm, asked the South African government for permission to sell inexpensive generic versions of eight of the 15 commonly used anti-HIV drugs, the New York Times reported March 10. Cipla has said it could offer an AIDS regimen for $600 per patient per year.

Recouping research costs

In their defense, the pharmaceutical companies argue that they need patent protection to recoup the vast sum it costs to research and develop drugs. They say it takes $1 billion to get a new medicine to market.

The Financial Times in a March 9 article considered that the decision by Merck to lower prices "could set an extremely dangerous precedent for the drugs industry" and lead to an "all-out price war." The same could occur for other patented drugs. The newspaper quoted Trevor Jones, director-general of the Association of the British Pharmaceutical Industry, who said, "While the industry is more than willing to do what it can, it cannot act as a sort of National Health Service to the world."

The Financial Times warned that if the industry cannot overcome the impression that it is willing to place the sanctity of patents above the sanctity of life, support for intellectual property on medicines could erode. "That would undermine the entire foundation on which drug research is built," the newspaper said.

The same paper, however, pointed out Feb. 17 that the patent system, which enables companies to recoup research costs and make profits, has a disadvantage: The price of patented medicines bears no relation to the cost of manufacturing them. And while companies claim that they operate in a competitive environment, when a medicine finally goes off patent, generic manufacturers can charge a tenth of the price and still make a profit.

Furthermore, the Financial Times argued, the industry's claim that it needs "super-profits" to undertake risky research investments is undermined by the huge amounts it lavishes on marketing. GlaxoSmithKline, the newly merged Anglo-American company, boasts that it spends $500,000 an hour on research and development. But it invests nearly twice as much in sales and marketing.

On the question of patent protection, the Guardian newspaper Feb. 12 contended that "patents are killing people." Moreover, the British paper said, intellectual property protection "has become a tool to make permanent the growing inequality of the global economy." The Guardian observed that the United States now accounts for 275,000 patent applications a year. By contrast, 26,000 patent applications were filed in 1997 to the African intellectual property organization and only 31 came from resident Africans.

Even at much lower prices, relatively few Africans can afford anti-AIDS drugs without outside assistance; the poorest nations have annual health budgets equivalent to $10 per person. So the next step could be action by the Group of Seven major industrial powers, the Wall Street Journal reported March 13. Pressure apparently is building to announce an anti-AIDS plan at the G-7 summit in Genoa, Italy, this June.

Italy, which is hosting the summit, has proposed creating a trust fund of at least $1 billion -- part from governments, part from private companies -- that would be managed by the World Bank and would fight AIDS, tuberculosis, malaria, dysentery and other diseases.

A way has to be found whereby drug companies receive sufficient protection in order to have a financial incentive to keep producing new products. At the same time it is clearly unjust to charge Third World countries the same prices for treatment that people in the richest nations pay.
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Work and Motherhood: Still a Hard Balance
Opportunities Are Greater, But Risks Remain

NEW YORK (Zenit.org) - Women are more successful in building careers, even if difficulties still exist.

The Wall Street Journal on March 1 reported on a study it did, looking at 30 influential businesswomen in Europe. It noted that among the top 50 business schools worldwide, the European institutions' percentage of women students, 26%, was catching up to the U.S. level of 30%.

Yet the number of women executives was limited. Ann-Kristin Achleitner, a banking and finance professor at the European Business School, offered an explanation: "To get into influential positions at big companies you have to have been working for 10 to 15 years -- and there are few women over here who have really done that."

In the United States, women also have difficulties in reaching the top. Business Week magazine in its Nov. 27 issue observed that while 45% of all managerial posts are held by females, only two of the nation's 500 biggest companies have female chief executive officers: Carly Fiorina at Hewlett-Packard and Andrea Jung of Avon Products.

The World Bank's Development Indicators for 2000 show a global average of female participation in the work force of 40.5%. The study, however, warns this underestimates the number of women in the labor force, because many work on farms or in family enterprises without pay.

"A very poor bargain"

During the last decades frequent battles have been fought to achieve equality of opportunity for women in the workplace. Many barriers to women have been broken, although the situation varies greatly from country to country.

One issue now under examination is how women can find equilibrium between work and the family. A survey conducted as part of the Wall Street Journal study found that half of the women interviewed said they had enough time with their children and an option to return to work. But another 36% who have children at home feared missing out on advancement while on maternity leave.

These divisions were reflected in a debate in Australian newspapers over how to balance motherhood and work. In the Sydney Morning Herald on Feb. 27, Bettina Arndt argued that "women who trade having children for a career may find they've made a very poor bargain."

Arndt observed that the desire to get ahead at work seems to be a major factor why growing numbers of Western women are remaining childless. The danger in this is that a growing number of women rely on career satisfaction as their major source of lifetime fulfillment. In Arndt's opinion "this is likely to prove a very risky course."

Arndt quoted several studies, of men, demonstrating that success at work often does not fulfill their expectations of what constitutes the good life. Arndt also enlisted the support of feminist Betty Friedan. In Friedan's book "The Fountain of Age," recent research shows that older women who have combined marriage, motherhood and work demonstrate the highest psychological well-being, significantly greater than women who were neither married nor mothers.

In reply, Dorothy Cook, in The Age newspaper on March 8, argued that there are many reasons for women's hesitancy about having children -- a principal one being that "we live in an anti-child economy of long work hours and high child-care, education and housing costs."

Even if women's emotional desires are important, "they are constrained by the reality we see around us." Today's world, observed Cook, "is faster, more fragmented, more bewildering, and consumer-driven. Intimate relationships are harder to establish and maintain in the grip of a savage consumer culture that is inherently anti-child and anti-intimacy."

Another opinion came from Catherine Keenan in the Sydney Morning Herald on March 9. Most women still want children in marriage, Keenan argued, but today marriage and children are being put off until later in life, and relationships often end, either in separation or divorce, before the kids come along. When families break up, it is normally the women who keep the children -- and the specter of being a lone mother leads many women to put off having children.

To resolve the problem, Keenan affirmed that "we need workplace conditions designed for the needs of families, not individuals, and men who take more seriously the responsibilities of fatherhood."

On a personal level, Amber Rust wrote about her experiences for The Sunday Times on March 11. An Oxford graduate, she decided to forsake a career and now, aged 28, has two children. She noted that none of her friends has started a family, preferring to dedicate themselves to work.

Rust observed that having kids first was financially difficult, because she was still paying off her student loans. Moreover, finding a job now with the necessary flexibility to care for children is difficult. She does not regret her decision to start a family and sacrifice her job prospects. But she would like to find a way to "do justice to myself and my education without working long hours in an office."

In an earlier article, Bettina Arndt argued in favor of more opportunities for part-time work. In the Sydney Morning Herald on Dec. 23, Arndt quoted research by a London School of Economics sociologist, Catherine Hakim. The research showed that while 10% to 30% of women opt for complete dedication to work, an equivalent number leave the work force to dedicate themselves to the family. The rest look for a way to combine the two.

Hakim's book, "Work-Lifestyle Choices in the 21st Century," finds that women who wish to combine working with caring for their children are increasing limiting their families to one child, particularly in countries such as the United States and France.

The study points out that at some stages of their lives, when women don't have children, they might work full time. But when they have children, they might step back completely or go to part-time work.

Ann Crittenden commented in her recent book, "The Price of Motherhood: Why the Most Important Job in the World Is Still the Least Valued," that motherhood carries a steep price tag, mostly in lost wages and benefits. Crittenden worked for about 20 years, the last eight of them at The New York Times, before leaving to raise her son. Just looking at lost wages alone, she figures motherhood has cost her between $600,000 and $700,000 for the 15 years she devoted to her son.

Crittenden, according to a Business Week review March 2, is a "committed feminist," but is disappointed that mainstream feminist organizations still devalue motherhood and a woman's role in the family. Among the reforms Crittenden supports is a shorter workweek, more generous leave policies, family-friendly tax reform, and universal preschool for 3- and 4-year-olds.

The arguments over how to reconcile equality, work and the family are complex. But an increasing number of women realize there is a need to fight for equality not only in the workplace, but also in achieving greater recognition of the value of motherhood.

Discrimination occurs not only when women are denied promotions or the ability to enter in certain occupations, but also when they are not able to find a way to remain in the work force part time when they have children, or return to work after taking off a few years to raise a family.

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