Millions for Viagra, Pennies for the Poor

Almost three times as many people, most of them in tropical countries of the Third World, die of preventable, curable diseases as die of AIDS. Malaria, tuberculosis, acute lower-respiratory infections--in 1998, these claimed 6.1 million lives. People died because the drugs to treat those illnesses are nonexistent or are no longer effective. They died because it doesn't pay to keep them alive.

Only 1 percent 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 thirteen out of 1,223 medications. Only four of those thirteen resulted from research by the industry that was designed specifically to combat tropical ailments. The others, according to a study by the French group Doctors Without Borders, were either updated versions of existing drugs, products of military research, accidental discoveries made during veterinary research or, in one case, a medical breakthrough in China.

Certainly, the majority of the other 1,210 new drugs help relieve suffering and prevent premature death, but some of the hottest preparations, the ones that, as the New York Times put it, drug companies "can't seem to roll...out fast enough," have absolutely nothing to do with matters of life and death. They are what have come to be called 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.

The drug industry's calculus in apportioning its resources is cold-blooded, but there's no disputing that one old, fat, bald, fungus-ridden rich man who can't get it up counts for more than half a billion people who are vulnerable to malaria but too poor to buy the remedies they need.

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."

US 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 US troops to the hospital. With the end of a ground-based US military strategy came the end of innovation in malaria medicine.

The Pharmaceutical Research and Manufacturers of America (PhRMA) claimed in newspaper ads early this year that its goal is to "set every last disease on the path to extinction." Jeff Trewhitt, a PhRMA spokesman, says US drug companies will spend $24 billion on research this year and that a number of firms are looking for cures for tropical diseases. Some companies also provide existing drugs free to poor countries, he says. "Our members are involved. There's not an absolute void."

The void is certainly at hand. Neither PhRMA nor individual firms will reveal how much money the companies spend on any given disease--that's proprietary information, they say--but on malaria alone, a recent survey of the twenty-four 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 ten years to develop a new drug, so we could soon face [a strain of] malaria resistant to every drug in the world." A 1996 study presented in Cahiers Santé, a French scientific journal, found that of forty-one important medicines used to treat major tropical diseases, none were discovered in the nineties and all but six were discovered before 1985.

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