Several months ago a producer at the BBC named Poppy Sebag-Montefiore asked me whether I would consider submitting a piece about Fire in the Blood to the web edition of one of the world’s most respected academic publications, History Workshop Journal (HWJ, Oxford University Press).  I leapt at the chance, both because of the obvious prestige of the platform as well as what I saw to be a brilliant opportunity to lay out the historical context and magnitude of the events depicted in the film, and to do so in greater depth than that generally afforded by the strictures of journalism.

I am deeply grateful to Poppy and the editors at History Workshop for the opportunity to contribute this essay about Fire in the Blood and why it needed to be made.  Here is an excerpt, and a link to the full text appears at the bottom of the post.

“The more one explores the prevailing system of developing and commercializing medicine, the more one is struck by its essential contradictions.  The system of “intellectual property” rights, which originally evolved on the principle of serving the public interest, seems in this case (as in many others) to do almost precisely the opposite.  Those who claim to be “innovators” have no apparent interest in innovating outmoded business models which are disastrously flawed and utterly ill-suited to alleviating public health problems.  Companies which claim they need to charge astronomical prices in order to recoup their huge expenditures on innovative research actually do precious little such research, and spend vastly more on marketing, lavish executive salaries and paying lawyers to extend their lucrative monopolies.  Meanwhile, governments which actually fund the overwhelming proportion of global basic drug discovery research all but give the fruits of this research away to giant, profit-crazed corporations, which then proceed to sell the resulting products back to government and the public at wildly inflated prices, meaning that many of the luckless taxpayers whose money funded the breakthrough research in the first place will suffer and die without receiving any benefit from it (and may well go bankrupt in the process).

Regulating “Big Pharma” is the only area of politics I can think of where you find people on the right side of the political spectrum howling in favour of government-granted monopolies, while those on the left loudly bang their drums for “free market competition” and denounce patent restrictions for “distorting the marketplace” and “not allowing capitalism to function.”

Having spent so many years working on this project, consciously attempting not to take an ideological approach to the subject, I nonetheless often find myself astonished that we find ourselves where we do with medicine, given that the stakes are so incredibly high and we are clearly doing such an abysmal job at it.  84% of worldwide research for basic drug discovery comes from government and public sources (Light, BMJ, 2012), and the proportion of public money only rises where life-saving drugs are concerned.  Yet the world, both rich and poor, is getting a terrible deal, despite investing tens of billions of taxpayer dollars per year on finding new and better drugs.  The levels of profiteering on patented medicines are shocking, and out of all proportion to the expenditures involved.  Yet of course this can only happen with the complicity of officialdom.  I often say that the real villains of this story are not pharmaceutical companies or their fearsome lobby, but national governments which instead of fulfilling their mandate to protect the public interest, and in particular to safeguard the basic well-being of the most vulnerable in society, invariably do the exact opposite when it comes to pharmaceuticals.  One can speculate as to precisely why this is, but where such vast sums of money are concerned, the conclusions are unlikely to be surprising.  The companies, meanwhile, behave more or less as any capitalist entity might be expected to under the existing framework, using their “fiduciary duty” to maximize profits for shareholders as a fig leaf whenever anyone asks.

Far from improving, things are actually getting progressively worse.  Using international trade mechanisms, Western governments led by the United States continue to work relentlessly to cut off supplies of affordable generic drugs to low- and middle-income countries, and if anything have only redoubled their efforts in recent years.  Many of these schemes are now entering their end games, in particular the proposed EU-India “free trade” agreement and the multi-country trade deal known as the Trans-Pacific Partnership (TPP), both of which contain harsh provisions intended to expand markets for Western brand-name drug producers at the expense of access to affordable medicine for huge swaths of the world’s population.  Which is why it is sadly no exaggeration to say that a catastrophe like the one which occurred during the years lower-cost generic AIDS drugs were withheld from Africa may just be a taste of things yet to come.  As Dr. Peter Mugyenyi, director of Africa’s largest Aids research and treatment centre told me a short time ago, “We are on standby awaiting another bloodbath.”

The full article is available here.