mailbox_small.gifI’m at work on a longer post that hasn’t yet come together, so I thought I’d pull an old dodge favored by daily newspaper columnists and respond to some reader comments instead. Fortunately for me, both comments left here in the past day or so have been thought-provoking — maybe there’s hope for the Internet after all.

With respect to the tussle over patents and drug pricing in Thailand, Gal Josefsberg wrote:

I’m not sure how they expect to get cheap HIV drugs if the destroy the company’s profits. I know we all think these sort of drugs should be cheap, but there’s an enormous cost to developing and testing them. Without some kind of profit motive, the R&D spent on these treatments will go down. I’m not saying the pharma companies should gouge HIV patients, but just saying “thanks for developing this drug, we’ll take it from here” is not the right answer.

Where AIDS drugs in the developing world are concerned, the arguments tend to be a little more complicated than I may have suggested. Some pharma and biotech companies — I’m most familiar with Gilead Sciences, although I believe others do this as well — explicitly acknowledge that it’s wrong to profit from the world’s poorest nations and set what they call “no-profit” prices for HIV drugs in almost 100 countries. Of course, they still plan to make out handsomely in the U.S., Europe and other industrialized parts of the world.

Things, however, get quite a bit murkier in “middle income” nations like Thailand, where the population as a whole is unquestionably getting richer, but where many of the people who need the drugs most are also still quite poor. Critics argue that it’s the responsibility of the Thai government to help its citizens afford drugs, and while they have a point, I’m not convinced the drug companies are wholly blameless. Many of them have only grudgingly begun efforts to cut poorer nations some slack on the price of life-saving drugs, following years of protest by AIDS activists and international organizations. Given that many activists still think companies like Abbott are trying to profiteer in developing-but-not-exactly-wealthy nations like Thailand, it’s no wonder that distrust of the pharmas still runs high in many quarters.

By the way, Brazil has apparently issued a similar threat to Merck over its HIV drug efavirenz (via Pharmalot).

In response to an item on the tactics drug reps use to push their product on doctors, RJ notes:

the first paper seems to be describing a phenomenon known as “sales”– truly a beauty to behold when it’s done well. No matter whether you’re selling drugs or enterprise software. That’s why the great sales people are paid so much. They’re artists.

That paper was written so vividly that I couldn’t help but wonder if Ahari, the former Lilly rep, doesn’t kind of miss his old job for exactly those reasons. There’s definitely something awe-inspiring about watching a professional salesperson at work, although I’d feel better about admiring it here if the sales job wasn’t specifically designed to override a physician’s best medical judgment — which is, after all, what the patient needs most and what insurers are supposed to be paying for.

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