ROUND TABLE DISCUSSION
Access to Life
As part of the 15th Thessaloniki Documentary Festival, a round table discussion took place on Saturday, March 23, 2013 at the John Cassavetes theater. The issue discussed was entitled “Access to Life”, as it related to Dylan Mohan Gray’s film Fire in the Blood, which screened in this year’s edition of the Festival. The main subject of the discussion was access to generic medication and how the drug manufacturers as well as governments consciously limit it. Participating in the discussion were Dr Apostolos Veizis, Head of Programs and Institutional Relations at Doctors Without Borders, Dr Alexis S. Benos, Professor In Social Medicine & Primary Health Care, and the film director Dylan Mohan Gray via Skype.
The director opened the discussion, noting that the main subject in the generic medication issue is the monopoly on patents that the drug manufacturers maintain. “This doesn’t only affect price differences. If, for example, the bird flu develops into a pandemic, governments will not leave the population without medication”, he explained. Mr. Gray commented on the situation in Greece, saying that drug manufacturers are doing everything in their power to keep their market share and their profits, and asked people not to think that multinationals are invincible.
Asked how he decided to make the film, the director noted that the idea was born in 2004, when he read an article about generic retroviral medication. He got in touch with the people mentioned in the article, but he had already decided to make a documentary. “I realized that information was scant, there were only some minor publications and the issue remained in the shadows. But its importance led me to the decision to make this film”. As the director noted, the project faced many challenges, since it combined issues of health, politics and international trade as well as patent legislation, while there was also a strong social dimension to the issue of patients with HIV-AIDS. The basic conclusion he reached was how dangerous monopolies are in the health field. “The pharmaceutical companies claim that research and production are extremely expensive, but this is not the case. The pharmaceutical companies invest much more in drugs such as Viagra. 80% of research is financed through public funds, and this is why governments must stop giving monopoly rights to private enterprises that do not serve the common good”.
Apostolos Veizis, Head of Programs and Institutional Relations at Doctors Without Borders (DWB), presented interesting facts about the access of different populations to medical treatment. As he explained, DWB have been active since 1971, and today are present in 65 countries, providing health services to 8 million patients. 200,000 HIV-AIDS virus patients are provided with medical treatment in their clinics, along with 30,000 tuberculosis sufferers, and 50,000 Kala-Azar (Visceral leishmaniasis) patients. According to the organization’s figures, one third of the world population does not have access to specific medications, since they are either too expensive or because their production has stopped because the pharmaceutical companies decided they were not profitable. In 1996 the drug companies raised the prices of retroviral medication for the treatment of HIV-AIDS to $15,000 dollars per patient per year. Then there were campaigns asking for access to basic medication and pressure was brought to bear on governments and companies in order for them to invest in research. Today, the DWB use generic drugs for treatment, which cost $80 dollars per patient per year (with an efficacy of 95 to 98%), while the cost of patent medications remains at $15,000 dollars. In 2003 the DWB campaigned for medications for “forgotten diseases”, so that public agencies would do research and develop medications thus avoiding the development of patents. Mr. Veizis gave the lack of research into tuberculosis as an example, which is still being diagnosed using 19th century methods, while vaccines against the disease are the same as in 1920 and the medications from 1950. 1.7 million people die from tuberculosis each year, even in our time.
Mr. Veizis said: “Today there is a battle going on between the EU and the government of India, a large generic drug producer, in order to make a trade agreement. Things are getting harder on a global level and by 2016 even the less developed nations will have stricter patent laws. In the name of protecting innovation and in the name of the financial crisis, our ammunition as doctors is being whittled away”. Mr. Veizis asked the audience to participate in the campaign about the agreement being worked out between the EU and India.
Professor Alexis Benos commented that even if the pharmaceutical companies pay fines in the amount of 1.5 billion dollars, as it happened in the case of the Eli Lilly drug company in the USA, their profits are still huge.
Speaking about conditions in Greece, he noted that in the last decade the successive Ministers of Health “managed to slander generic medications. We spoke for generic medication as much as we could, and we were then told that we were ‘on the take’ from generic drug manufacturers. In countries such as France and Great Britain, generic medications are regarded as matter of fact. In the end, generic medication was adopted in the name of political control of public spending, but it was done in the wrong way. Based on ministerial decisions, the price of generic medications must be 80% of the price of the patented medication. Today control mechanisms have been completely dismantled and we have no way of knowing the real composition and quality of medications”.
The basic question for Mr. Benos is if medication is a commodity or a social good. As he said, malaria may be of concern to millions of people, “but the pharmaceutical companies were never interested because the market is small. The pharmaceutical industry wants profits and this is why it creates new needs, lifestyle drugs for consumers in the Western world. From 1975 until 2004, 1556 new medications were created. Only 1.3 of these was for diseases that cost lives”. For him, what is important is: “to have a national pharmaceutical industry to meet needs, not for profit. You can’t expect this from a private company, only from the public system”.
A medical specialist present observed that the medical world remains hesitant since generic drugs were represented as drugs that do not go through the same certification process (only when compared to the prototype), and questions were raised as to whether sanitary standards and quality control were being adequately observed since they are being manufactured in non-Western countries. Mr. Gray commented that quality control standards are just as strict in India as they are set by the FDA in the USA, and in any case generic retroviral medications are financed through a world fund and receive certification from the World Health Organization before being exported to Africa. “Often, the controls are particularly strict and the manufacturing facilities much more modern compared to countries in the developed world. In Greece, from what I understand, there is an enormous amount of misinformation. It is shocking that there hasn’t been proper information given on generic drugs”, he concluded.