Filmmaker’s message for Artículo 31

Hello from Bombay and a million thanks to Médicos del Mundo for including my film, Fire in the Blood, in the Artículo 31 Film Festival!

On the surface of things this film is about HIV/AIDS, global health, the pharmaceutical industry and access to lifesaving medicine, but for me it is fundamentally about money, power and how we treat our fellow human beings. I truly wish I could be there with you in Madrid this evening, not least because I have received so many passionate responses to this film from people in Spain since I had the profound honour of presenting it at the Seminci in Vallodolid in late October.

I am especially happy to know that many doctors, medical professionals, activists, policymakers and others interested in global public health will be there in the audience tonight.

The experience of having to watch a patient, friend or relative die a horrible, agonising death for the uniquely infuriating, idiotic and utterly indefensible reason that there is a patent monopoly in force which makes it possible for a drug company to price the medicine which could save those people’s lives far out of reach to them, their communities, their governments or even donor programs which might help them is one which will haunt the people in our film for the rest of their days.

I say to citizens of all Western countries, especially of European Union member states, including Spain, and of the United States of America: your governments are working relentlessly to incrementally augment the profits of giant pharmaceutical companies by effectively killing millions and millions of extremely vulnerable people every year, and they are doing it IN YOUR NAME. You have to decide after seeing Fire in the Blood whether that situation is one you are content to live with. I sincerely hope the answer will be “no” and that you will be as inspired by the people in this film — who took on the most powerful governments and corporations in the world, with no conceivable chance of success — as I was, and will pick up the baton from them to ensure that a “holocaust against the poor” such as that we depict in Fire in the Blood can never be allowed to happen again!

Thank you so much for taking the time to come and see our film, and thank you again to the organisers of this festival for deciding to show it.

All the best for the festival!

……………

Hola desde Bombay y un millón de gracias a Médicos del Mundo por la inclusión de mi película “Fuego en la Sangre”, en el festival de cine ARTICULO 31!

En la superficie esta película trata acerca del VIH/SIDA, la salud global, la industria farmacéutica y el acceso a medicamentos que salvan vidas, pero para mí es fundamentalmente sobre el dinero, el poder y la forma en que tratamos a nuestros semejantes. Yo realmente desearía poder estar allí con ustedes en Madrid esta tarde, sobre todo porque he recibido tantas respuestas apasionadas hacia esta película de la gente en España desde que tuve el honor de presentarla en la Seminci de Valladolid a finales de octubre.

Estoy especialmente contento de saber que muchos médicos, profesionales de la medicina, activistas, legisladores y otras personas interesadas en la salud pública mundial estarán entre el público esta noche.

La experiencia de tener que ver que un paciente, amigo o pariente mueren una muerte agonizante horrible por la razón única indignante, estúpida y absolutamente indefendible de que hay un monopolio de las patentes en vigor que hace posible que una compañía farmacéutica fije el precio de los medicamentos que podrían salvar la vida de esas personas lejos de su alcance, de sus comunidades, de sus gobiernos o incluso de programas de donantes que podría ayudarles es …

Yo digo a los ciudadanos de todos los países occidentales, especialmente de los Estados miembros de la Unión Europea, entre ellos España, y de los Estados Unidos de América: sus gobiernos están trabajando sin descanso para aumentar gradualmente los beneficios de las compañías farmacéuticas gigantes por millones de matar con eficacia y millones de personas con extrema vulnerabilidad cada año, y lo están haciendo a su nombre.

Usted tiene que decidir después de ver Fuego en la Sangre si esa situación es la que usted está contento de vivir. Espero sinceramente que la respuesta será “no” y que va a ser tan inspirado por el pueblo en esta película – que asumieron los gobiernos más poderosos y las corporaciones en el mundo, sin posibilidad concebible de éxito – como yo, y recogerá el testigo de ellos para asegurarme de que un ” holocausto contra los pobres” como la que representamos en Fuego en la sangre nunca se puede permitir que vuelva a suceder!

Muchas gracias por tomarse el tiempo para venir a ver nuestra película, y gracias de nuevo a los organizadores de este festival para decidir mostrarlo.

Todo lo mejor para el Festival

A recent article which appeared in the business pages of the New York Times about a comparatively small, US-based pharmaceutical company called Questcor is of far more interest than one might initially expect…

Questcor has just one main product, a 60 year-old drug which it sells for $28,000 a vial.  The same drug (HP Acthar Gel, used in the treatment of “immune-related disorders like multiple sclerosis and nephrotic syndrome”) cost a mere $40 a vial when Questcor acquired rights to it for the princely sum of $100,000 in 2001, and “just” $1650 as recently as 2007 (Questcor’s R&D; expenditure for the drug was negligible and they made $509 million on it last year).

When Questcor got word that a comparable drug called Synacthen (developed by the Swiss pharma conglomerate Novartis) was scheduled to come on the market and likely to be sold for “just” a few hundred dollars per vial, they quickly bought up the rights for $135 million so they could put Synacthen on the shelf and keep making insane profits at patients’ and providers’ expense.  They likewise secured exclusive rights to Synacthen in numerous other countries, presumably so desperate patients would be less likely to be able to go buy it elsewhere and bring it back to the US, thus doing an end-run around Questcor’s exorbitant and cynical price.

The company’s stock price jumped 15% on the day the deal was announced.

This little story tells you pretty much all you need to know about the true face of monopolies on essential medicine.

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.

– DMG –

Fire in the Blood screened at the Royal Society of Medicine (RSM) in London on May 28th, followed by a panel discussion with Nathan Ford of the World Health Organisation (WHO), John Saunders, Chair of the Ethics Committee of the Royal College of Physicians, Harry Thangaraj, Director of the Access to Pharmaceuticals Project at St. George’s, University of London, Guppi Bola of Oxfam and Kush Naker of Universities Allied for Essential Medicines (UAEM).

Details of this event here.

Director Dylan Mohan Gray was not able to be present for the screening, but sent the following remarks by way of introduction:

“Greetings to everyone at the Royal Society of Medicine from steamy Bombay!

It’s truly an immense honour for all of us involved with Fire in the Blood to have been invited to screen our film at your renowned institution, and honestly I can scarcely think of a more perfect venue for it.  I deeply regret not being able to be with you in person this evening, but given the lineup of panelists I’m quite sure you will find the post-screening discussion to be extremely stimulating, and of course I hope most of you find the film to be of interest as well.

Since you haven’t yet had a chance to see it, I won’t talk much about Fire in the Blood, other than to say it is not, as some would have it framed, a project intended to attack the brand-name pharmaceutical industry.  The film critiques the system by which medicines become subject to monopoly, and in that sense its target is political.

Nonetheless, it is certainly true that the biggest obstacle to reforming the current system is the dogged intransigence of the international pharma industry, which as everyone in this room well knows has almost unfathomable financial resources and political clout.  90% of the billions upon billions of pounds this industry spends on marketing every year is directed at doctors, whose relationships of trust with their patients the companies seek to leverage for commercial gain.

As you will soon see, a number of the leading figures in Fire in the Blood are medical doctors who stood up against a system which didn’t value their patients’ lives.  To me, these people are true heroes, and embody the very best ideals of your profession.

Still, doctors in the UK and throughout the world need to do considerably more to change the basic equation of access to medicine, which affects billions of people in rich countries as well as poor.  There have been very promising developments in the UK in recent months, of which no doubt most of you are already well aware, such as the growing momentum for open access to taxpayer-funded research, and the “all trials” campaign for every clinical trial to be registered and full results reported, not just those which suit the commercial interests of pharma companies.

I hope that after seeing Fire in the Blood many of you will agree with me that it is possible to properly fund and incentivise vital research without making its benefits inaccessible to the vast majority of the world’s people.  Any of you interested in finding out more are encouraged to visit our film’s website, and please feel free to write and share your thoughts with me as well.

Thank you so very much for coming tonight, I really hope you find it to be a particularly memorable and thought-provoking evening!”

We had two outstanding screenings in Geneva this past week.

The first was at the Press Club of Switzerland, sponsored by the MSF Access Campaign.

It was a full house of around 150 people and the audience was exceptionally knowledgeable and attentive. Even though it came in the middle of the World Health Assembly (WHA), where people typically run between meetings, sessions and events the entire time, it was really gratifying to see the audience fully absorbed in the film, with only one or two people rushing off apologetically before the post-screening discussion (which went on for almost an hour) was finished. A number of people came up to me afterwards and told me they were in tears for much of the screening, something which always takes me a bit by surprise, to be honest, but especially so when the audience is so overwhelmingly ‘expert’ in nature, with a high proportion of the attendees having worked for years or in many cases even decades on issues of access to medicine.

The post-screening panel was comprised of Mohga Kamal-Yanni from Oxfam, Rohit Malpani from the MSF Access Campaign, Jamie Love from Knowledge Ecology International (KEI) and myself. The moderator was policy consultant Spring Gombe, who earlier worked with MSF, KEI and Health Action International.

It was a very lively and interesting discussion, the audience was totally international, with what seemed like dozens of countries represented, and much of the discourse focused on the need to ‘de-link’ incentives for pharmaceutical R&D; from the price of end products, i.e., medicines. With the debate on a global R&D; treaty raging during the WHA, this event and the screening of FITB could scarcely have been more timely or relevant.

The response to the film itself was extremely positive, with many people eager to find out how they could make use of it in their advocacy and educational work, and others interested in having it screened in their home countries and at various intergovernmental organisations.

Brittany Ngo and William New filed a report on the event for Intellectual Property Watch, which can be read here.

The next day it was much the same story at UNAIDS headquarters. Another excellent, highly knowledgeable, large, engaged, extremely international audience came to see the film and was exceptionally attentive. There was a big ovation at the end of the screening and a really good panel discussion with two HIV-positive people, both long active in the fight for access to AIDS medicine (and both of whom had very interesting insights and were full of praise for the film), as well as myself. The discussion went longer than planned, but again virtually nobody left and many people came up to talk with me afterwards.

After the experience at the WHA I definitely feel a renewed sense of energy and belief that this film can play a huge role in accomplishing something truly monumental. It can even be so valuable in terms of “re-engaging” people who have been working on or connected with these issues for many years, but who can often (as I was repeatedly told in Geneva) to some extent find themselves forgetting exactly what it is they are fighting for as they get bogged down in endless bureaucracy, negotiations and inertia — and for these people Fire in the Blood can serve as a great wake-up call and reminder of what all of this is really about: human beings and the fundamental right to a healthy life.

– DMG –

Fire in the Blood won the 2013 DOXA Feature Documentary Award at DOXA in Vancouver on May 12th, in a unanimous decision by the jury.

Read the jury citation here.

Director Dylan Mohan Gray sent the following statement which was read at the awards ceremony in Vancouver:

“On behalf of everyone involved with Fire in the Blood, I would like to express our immense gratitude to the jury, the festival organizers and the audiences at DOXA for this wonderful and totally unexpected award.  To win top honours at one of the world’s great showcases for nonfiction film, especially as a fledgling Indian production, is incredibly humbling, and it is hard to put into words what this recognition means to all of us.  I am so sorry not to be able to be with you in person today to accept this award, but unfortunately my optimistic plans fell victim to some unavoidable scheduling conflicts.  At the same time, I have been deeply moved by the messages and feedback I have received from numerous friends and strangers in Vancouver, even before winning this prize, and it is an absolutely thrill to know that our film has touched such a nerve there.

Today being Mother’s Day, my thoughts are naturally of my own mother, who passed away several years back.  She was a child refugee who spent much of her life in poverty, and also worked for many years as a nurse.  One of the things she loved most about Canada and Canadians was their strong, universal belief in the idea of a fundamental human right to health, a conviction that healthcare must never be viewed as a privilege, and the vital principle that the poor and middle-class should receive the very same level of care as the rich.

Unfortunately, we live in a world where healthcare is primarily viewed through a prism of economic opportunity and the promise of enrichment for a small cadre of corporate bosses, and artificial scarcity is regarded as the key to maximizing their profits.  The system we detail in Fire in the Blood is one in which millions of mothers are forced to watch their children suffer and die of treatable and preventable ailments, denied access to medicine which can be easily, cheaply and safely produced in order to ensure that a handful of giant monopoly-holding corporations can maintain almost unfathomable profit margins selling drugs which were more often than not discovered through taxpayer-funded research.  We believe that Fire in the Blood can start a global conversation with the potential to positively impact the lives of literally billions of our fellow human beings.  To everyone at DOXA, thank you a million times over for supporting this project, for helping to get it seen by as many people as possible and, in a small but significant way, being part of ending monopolies on essential medicine.  The characters of Fire in the Blood are living proof that it is possible to do the unthinkable, to take on the most powerful governments and corporations on the planet, and – if the cause is just – to change the world.  Many, many thanks once again to all of you on their behalf, and on behalf of those of us who have tried to do justice to their story.”