MILLIONS FOR VIAGRA, PENNIES FOR THE POOR

People in the Third World die of curable diseases as Western drug companies
create `lifestyle drugs'

One old, fat, bald, fungus-ridden rich man who can't get it up means more
to the pharmaceutical industry than half a billion poor people vulnerable
to malaria.

And almost three times as many people - most in tropical areas of the Third
World - die of preventable, curable diseases as die of AIDS.

Malaria, tuberculosis, acute lower respiratory infections claimed 6.1
million lives in 1998. People died because the drugs to treat those
illnesses are non-existent or are no longer effective. They died because it
doesn't pay to keep them alive.

Only 1 per cent of all new medicines brought to market by multinational
pharmaceutical companies between 1975 and 1997 were designed specifically
to treat tropical diseases plaguing the Third World. In numbers, that means
13 out of 1,223 medications.

Certainly, the majority of the other 1,210 new drugs help relieve suffering
and prevent premature death, but some of the hottest preparations have
nothing to do with matters of life and death. They are lifestyle drugs -
remedies that may one day free the world from the scourge of toenail
fungus, obesity, baldness, face wrinkles and impotence.

The market for such drugs is worth billions of dollars a year and is one of
the fastest-growing product lines in the industry.

Western interest in tropical diseases was historically linked to
colonization and war, specifically the desire to protect settlers and soldiers.

Yellow fever became a target of biomedical research only after it began
interfering with European attempts to control parts of Africa. "So obvious
was this deterrence . . . that it was celebrated in song and verse by
people from Sudan to Senegal," Laurie Garrett recounts in her extraordinary
book The Coming Plague. "Well into the 1980s schoolchildren in Ibo areas of
Nigeria still sang the praises of mosquitoes and the diseases they gave to
French and British colonialists."

U.S. military researchers have discovered virtually all important malaria
drugs. Chloroquine was synthesized in 1941 after quinine, until then the
primary drug to treat the disease, became scarce following Japan's
occupation of Indonesia.

The discovery of Mefloquine, the next advance, came about during the
Vietnam War, in which malaria was second only to combat wounds in sending
U.S. troops to the hospital. With the end of a ground-based U.S. military
strategy came the end of innovation in malaria medicine.

The Pharmaceutical Research and Manufacturers of America (PhRMA) claimed in
U.S. newspaper ads early this year that its goal is to "set every last
disease on the path to extinction." Spokesperson Jeff Trewhitt says U.S.
drug companies will spend $24 billion on research this year and that many
firms are looking for cures for tropical diseases. Some companies also
provide existing drugs free to poor countries, he says.

The void is certainly at hand. Neither the pharmaceutical manufacturers
association nor individual firms will reveal how much money the companies
spend on any given disease - that's proprietary information. But on malaria
alone, a recent survey of the 24 biggest drug companies found that not a
single one maintains an in-house research program, and only two expressed
even minimal interest in primary research on the disease.

"The pipeline of available drugs is almost empty," says Dyann Wirth of the
Harvard School of Public Health, who conducted the study. "It takes five to
10 years to develop a new drug, so we could soon face (a strain of) malaria
that's resistant to every drug in the world."

A 1996 study presented in Cahiers Sante, a French scientific journal, found
that of 41 important medicines used to treat major tropical diseases, none
was discovered in the '90s and all but six were discovered before 1985.

Contributing to this trend is the wave of mergers that has swept the
industry over the past decade. Merck alone now controls almost 10 per cent
of the world market.

"The bigger they grow, the more they decide that their research should be
focused on the most profitable diseases and conditions," one industry
watcher says. "The only thing the companies think about on a daily basis is
the price of their stocks. And announcing that you've discovered a drug
(for a tropical disease) won't do much for your share price."

That comment came from a public health advocate, but it's essentially
seconded by industry. "A corporation with stockholders can't stoke up a
laboratory that will focus on Third World diseases, because it will go
broke," says Roy Vagelos, the former head of Merck. "That's a social
problem and industry shouldn't be expected to solve it."

Drug companies, however, are hardly struggling to beat back the wolves of
bankruptcy. The pharmaceutical sector racks up the largest legal profits of
any industry and it is expected to grow by an average of 16 to 18 per cent
over the next four years, about three times more than the average for the
Fortune 500.

"It's obvious that some of the industry's surplus profits could be going
into research for tropical diseases," says a retired drug company
executive, who wishes to remain anonymous. "Instead, it's going to
stockholders."

And to promotion ($10.8 billion on advertising in 1998). And to politics.
(American drug companies spent $74.8 million in 1997 to lobby the U.S.
government. Last year they spent nearly $12 million on campaign contributions.)

Just 45 years ago, the discovery of new drugs and pesticides led the World
Health Organization to predict that malaria would soon be eradicated. By
1959, Garrett writes in The Coming Plague, the Harvard School of Public
Health was so certain that the disease was passe that its curriculum didn't
offer a single course on the subject.

Resistance to existing medicines - along with cutbacks in health care
budgets, civil war and the breakdown of the state - has led to a revival of
malaria in Africa, Latin America, Southeast Asia and, most recently,
Armenia and Tajikistan. The World Health Organization describes the disease
as a leading cause of global suffering.

For the drug companies, the meagre purchasing power of malaria's victims
leaves the disease off the radar screen.

Among the problems the pharmaceutical companies are scrambling to eradicate
are:

* Impotence. Pfizer invested vast sums to find a cure for what Bob Dole and
other industry spokespersons delicately refer to as "erectile dysfunction."
The company hit the jackpot with Viagra, which racked up more than $1
billion in sales in its first year on the market. Two other companies,
Schering-Plough and Abbott Laboratories, are rushing out competing drugs.

* Baldness. The top two drugs in the field, Merck's Propecia and Pharmacia
& Upjohn's Rogaine had combined sales of about $180 million in 1998.

* Toenail fungus. With the slogan "Let your feet get naked!" as its battle
cry, pharmaceutical giant Novartis recently unveiled a lavish advertising
campaign for Lamisil, a drug that promises relief for suffers of this
unsightly malady. The war against fungus involves a market estimated to be
worth hundreds of millions of dollars a year.

* Face wrinkles. Allergan earned $90 million in 1997 from sales of its
"miracle" drug Botox. Injected between the eyebrows at a cost of about
$1,000 for three annual treatments, Botox makes crow's feet and wrinkles
disappear. ``Every 7 1/2 seconds someone is turning 50," a wrinkle expert
told the Dallas Morning News in an article about Botox last year. "You're
looking at this vast population that doesn't want frown lines."

Meanwhile, acute lower respiratory infections go untreated, claiming about
3.5 million victims per year, overwhelmingly children in poor nations. Such
infections are third on the chart of the biggest killers in the world; the
number of lives they take is almost half the total reaped by the Number One
killer, heart disease, which usually strikes the elderly.

In some cases, older medications thought to be unnecessary in the First
World and commercially unviable in the Third have simply been pulled from
the market. This created a two-year crisis recently when TB re-emerged with
a vengeance in U.S. inner cities, since not a single company was still
manufacturing Streptomycin after mid-1991.

All the blame for the neglect of tropical diseases can't be laid at the
feet of industry. Many Third World governments invest little in health
care, and First World countries have slashed both foreign aid and domestic
research programs. Meanwhile, the U.S. government aggressively champions
the interests of the drug industry abroad, a stance that often undermines
health care needs in developing countries.

Given the industry's profitability, it's clear the companies could do far
more. It's equally clear that they won't unless they are forced to.

While the industry's political clout currently insures against any radical
government action, even minor reforms could go a long way.

At the beginning of this year, Doctors Without Borders unveiled a campaign
calling for increased access to drugs needed in Third World countries. It's
exploring ideas ranging from tax breaks for smaller firms engaged in
research in the field, to creative use of international trade agreements,
to increased donations of drugs from the multinational companies.

Campaign organizer Dr. Bernard Pecoul says different approaches are
required for different diseases. In the case of those plaguing only the
Southern Hemisphere - sleeping sickness, for example - market mechanisms
won't work because there simply is no market to speak of.

He suggests that if multinational firms are not willing to manufacture a
given drug, they transfer the relevant technology to a Third World producer
that is.

Drugs already exist for diseases that ravage the North as well as the South
- - AIDS and TB, for example - but they are often too expensive for people in
the Third World.

For 25 years, the World Health Organization has used funding from member
governments to purchase and distribute vaccines to poor countries. Pecoul
proposes a similar model for drugs to treat tropical diseases.

Another solution he points to: In the event of a major health emergency,
state or private producers in the South would be allowed to produce generic
versions of needed medications in exchange for a small royalty paid to the
multinational license holder.

"If we can't change the markets, we have to humanize them," Pecoul says.
"Drugs save lives. They can't be treated as normal products."