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April 23, 2005

There is no excuse

This Foreign Policy article by Tina Rosenberg explodes a lot of conventional wisdom about AIDS, and is well worth reading in its entireity. However, what  really surprised me was the fact that patients in poor countries are much, much, better about keeping up with their drug regiments for AIDS than us Americans, where only about 70% take the drugs on time as opposed to well above 90% in places like Camaroon, Uganda and Malawi. Shamefully, I had always unthinkingly bought into the racist trophe that Africans somehow less likely to follow the regiment correctly. At least I didn't go as far as Andrew Natsios, who runs the U.S. agency for International Development by the way, by speculating that African simply lack the western concept of time necessary to take retroviral drugs on schedule.

So why are we so bad at taking our medicine compared to Africans? Rosenberg speculates that there is more community support in Africa, and since AIDS have been so devastating, the consequences of not taking your medicine is much more salient. But she bought up another point -- whereas an American patient needs to take a whole handful of different drugs to get the full cocktail required to stay healthy, Africans have access to generic drugs that combine all those medicines into one pill.

Why are we making it harder for our AIDS patients to get the medicine they need to stay healthy? Yes, I know that the pharmaceutical companies aren't charities and they're not going to give up their sweet, sweet, profits one day before their patent runs out, but you'd think they'd care enough about their customers to get together and make a combination pill that will be easier to take and simply split the revenue. Not only would they be making the lives of AIDS patients easier, they would also cut down on the chance of resistance in the AIDS virus developing because of incorrectly followed regiments. There is no excuse.

-- Battlepanda

April 23, 2005 | Permalink


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The ratio of patients who got infected via IV Drug Use as opposed to sexual contact is probably vastly different in Africa from the US. I don't know (or know if I trust) the stats on how people get infected, but it does seem as though the same people who fail to rinse a rig with bleach might be more inclined to fail to find and take their meds on time.

That is not to say that your point is invalid. Consolidating pills sounds like a good idea without much downside. But needle exchanges need to be a part of our strategy.

Posted by: jon | Apr 23, 2005 12:06:16 PM

My inner butthole protests!

A regiment is a military unit of ground troops consisting of at least two battalions, usually commanded by a colonel.

You prolly mean regimen.

Posted by: mk | Apr 23, 2005 12:52:06 PM

Oops! Pandas can't spell.

Yes. Regimen. And also "entirety" instead of "entireity". Doh!

Posted by: Battlepanda | Apr 23, 2005 2:15:06 PM

It's well known in medical circles that compliance goes down with multiple doses in a day; the more doses, the worse compliance. 70% compliance is actually extraordinarily high for a multidose regimen. I'm sure that the difference in number of doses is the major reason for the difference in compliance.

Posted by: Rebecca Allen, PhD | Apr 23, 2005 2:40:25 PM

I hate to sound conspiratorial... but... uh... maybe pharmaceutical comapnies don't have an interest in new AIDS strains not developing? I mean, if an anti-AIDS medication is still effective by the time its patent expires, then companies will lose a major revenue stream, without replacement. I'm not saying that they really are TRYING to get new strains to develop, but maybe they aren't really trying all that hard to prevent it either.

Posted by: Julian Elson | Apr 23, 2005 5:09:59 PM

Slightly off topic, but this idea should be out there--whenever the "what women deserve an op-ed" meme strikes again, Tina Rosenberg clearly deserves one. Her books on foreign politics are all as good as, if not better than, Friedman's "From Beirut to Jerusalem", and she's already on the NYT's fucking editorial board, or was recently. She'd add real meat to any page, not the fluff of a Dowd, Brooks or the libertarian schmuck the Times just added. Especially recommended, though 10-15 years old, is "Children of Cain," about Latin America. The chapter on the Shining Path should be required reading for anyone serious about terrorism.

Posted by: Exile in Colorado Springs | Apr 24, 2005 7:12:21 AM

Yup. Instead of a firestorm about why there aren't more women op-ed columnists, we should be asking why the heck are most op-ed columnists so crappy.

Thanks for the background on Rosenberg, btw, since I'm unfamiliar with her other work.

Posted by: battlepanda | Apr 24, 2005 1:31:58 PM

I'd question the community support angle. In most African countries there is a huge stigma around HIV/AIDS sufferers, even when they constitute up to a third of the population.

Posted by: Ginger Yellow | Apr 25, 2005 8:16:33 AM

The way the patent laws and FDA policies work in Africa and the United States makes it easier to create consolidated pills for the African AIDS drug market. Essentially, the pharmaceutical companies have waived some of their patent rights in such a way that a number of Indian generic drug manufacturers have been combining the components of a treatment regimen into a single pill, rather than requiring mutliple pills multiple times per day. In the United States, HHS and the FDA have been working with industry to get more consolidated pills on the market. A recent example is an agreement between Bristol-Myers Squibb, Merck and Gilead to develop a combination pill that combines Emtriva, Viread and Sustiva, which is a fairly popular treatment cocktail. That being said, Gilead did get a quid pro quo out of the deal by getting expedited (6 month) rather than normal (10 month) review of their new treatment Truvada, which combines Viread and Emtriva. Off the top of my head I can't remember if the triple-drug combination will be marketed domestically, but at least many drug regimens can now use Truvada rather than Emtriva and Viread as a portion of the regimen.

Perhaps we should also consider if the population in Africa receiving treatment may be self-selected for higher compliance?

Posted by: Martin | Apr 25, 2005 10:15:17 AM

People have been warned about HIV and AIDS for over twenty years now. AIDS has already killed millions of people, millions more continue to become infected with HIV, and there's no care specially for the poors one - so AIDS will be around for a while yet. However, some of us still don't know exactly what HIV and AIDS actually are.

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This is an estimate of the number of people who will die of AIDS and other treatable diseases over the course of the coming year, most of them in the poor countries of the developing world.

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In the United States, HHS and the FDA have been working with industry to get more consolidated pills on the market.

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