Patents are not the problem

Patents are often blamed for most of the problems afflicting the health care system. In this article published in the Montreal Gazette, on 21 April 2008, I point out that "Patents are not the problem". By focusing on patents rather than the wider ills that seriously affect healthcare service to the poor, we will not help improve the lot of the ordinary patients.

Thailand's health minister recently announced that the nation's state-run drug manufacturer, the Government Pharmaceutical Organization, would continue to violate the patents on four key cancer drugs. Health activists around the world applauded the move, apparently believing that intellectual property rights are an obstacle to bringing medicine to the world's poorest and sickest citizens.

But drug patents and drug prices aren't the main obstacle to Third World patients seeking treatment. The truth is that even if medicine were completely free, most developing nations lack the infrastructure to deliver it effectively. As Kevin De Cock, HIV/AIDS director at the World Health Organization, explained to Reuters last year, "You have health infrastructure that is dilapidated, and supply chains that don't exist."

For instance, cold storage is essential to preserving the effectiveness of many drugs. It's estimated that about 50,000 people die annually in India from snake bites, primarily because the anti-venom serum cannot be stored in most rural clinics because of a lack of refrigeration, thanks to an extremely unreliable supply of electricity.

Diagnostic facilities are also often ignored. It was recently estimated that of the 22 million pathological tests carried out across India each day, only 1 million may be done at accredited laboratories. In addition, there is very little information about the validity and reliability of many of these tests.

Regularly, drugs are not administered safely in hospitals. In India, the government admitted recently that nearly 70 per cent of the injections patients get might be unsafe. Often, patients stay away from hospitals - even when sick - out of fear that they might get infected with diseases like AIDS. Indeed, a 10-year-old boy from a poor family in eastern India was infected with AIDS at one of Delhi's premiere hospitals.

This is one reason why the Indian government failed miserably in its efforts to increase access to medicines even after abolishing product patents in 1972. Thirty years later, when the debate began as to whether India would be better served by re-establishing patent rights, less than 10 per cent of the nation's estimated 3.5 million AIDS patients were receiving any treatment whatsoever.

Then there is the issue of greed - not so much of the patent-holders, but that of many governments in poor countries.

Kenya, one of the world's most vocal proponents of the patent-is-the-problem-for-patients notion, levies a 38-per-cent tax on imported medicines - enormous markup that needlessly makes drugs too expensive for many sick Kenyans. Morocco and Tanzania tax medicines at a similar rate. Brazil, also a habitual offender of intellectual property, imposes a 28-per-cent tax. Peru's tax is 29 per cent.

In Thailand, the former government turned down an offer from the Global Fund (an international philanthropy) that would have provided resources to purchase generic medications certified by the World Health Organization - preferring instead to produce the drugs domestically.

The reality is that regardless of whether a nation respects drug patents, someone somewhere must pay the high research and development costs of the pharmaceutical industry. Otherwise, drugs cannot be developed.

Right now, American patients pay for most research costs through high drug prices. It's estimated that it costs $800 million to develop a new drug today. Many drug makers already sell many medications at much lower prices to poor countries. If the use of compulsory licences increases, they'll have little choice but to reduce humanitarian drug sales or increase prices in poor nations - as they would have to find a way to recoup that lost revenue.

The health activists who are urging a number of governments that are systematically confiscating patents from international drug companies might have good intentions. But if governments continue to expropriate patents, they will essentially kill the goose that lays the golden eggs - and along with it, the hopes of hundreds of millions of the world's sick who await tomorrow's cures.

By focusing on patents rather than the wider ills that seriously affect healthcare service to the poor, we will not help improve the lot of the ordinary patients.