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Amir Attaran How Do Patents And Economic Policies Affect Access To Essential Medicines In Developing Countries? Health Affairs, May/June 2004; 23(3): 155-166. [Abstract] [Full Text] [Figures Only] [PDF] [Supplemental Exhibit] [Reprints & Permissions]

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Patents And Access: Another Look

Connie Liu, Sanjay Basu, AIDS Program, Yale University School of Medicine   ( 11 May 2004 )

Patents And Access: Another Look 11 May 2004
Connie Liu, Global Health Chair American Medical Student Association, Sanjay Basu, AIDS Program, Yale University School of Medicine Send comment to journal: Re: Patents And Access: Another Look cwl6{at}case.edu Connie Liu, et al.	Amir Attaran concludes that patents only infrequently constrain access to WHO-classified "essential medicines" in poor countries. We find his study claims and methodology problematic. Attaran finds that key patented drugs, which are out of reach from over 40 million persons, are the exception to his conclusion; yet 40 million persons are a substantial exception by any reasonable standard.(1) He tries to argue that patents are insignificant by showing that small numbers of them are in poor countries; yet those patents that do exist happen to often correlate to the conditions of highest morbidity and mortality, and therefore constrain access for large numbers of persons. A more reasonable test of the influence of patenting on access would be to compare how many persons in need of particular drugs would gain or lose access or would have their access to drugs be unaffected if patents that did exist in their country were removed or modified. In fact, other assessments of the impact of patents on access have found profoundly different results from that published by Attaran, using existing empirical data.(2) Attaran also argues that the WHO essential medicines list that he uses as the basis for his evaluation does not use patent status as an explicit criterion for exclusion, and therefore does not unfairly bias his study's methodology. Yet “cost-effectiveness”--of which drug price is a key component--is used as a primary basis for including or excluding medicines from the WHO list. Local or regional variabilities in medicine needs are therefore unaccounted for through this approach, as are key second-line regimens needed for physicians to maximize their flexibility in treating difficult diseases. Attaran should be reminded that the very organizations and activists he criticizes were the main reason that key AIDS drugs and second-line therapies for drug-resistant tuberculosis are now included on the WHO list.(3) Attaran has failed to account for the full impact patents have on access to generic medications. Even when no patents exist within a small country, generic drugs can still effectively supply the market. Patents within larger markets, particularly in those countries with production capacity, are of primary concern because generics need to be able to sustain their production in these markets in order to export to the smaller and poorer locales that usually have little domestic manufacturing capacity. Finally, Attaran appears to have created a false dichotomy between patents and poverty. We are all well aware that numerous factors constrain access to medicines and hinder their appropriate delivery, with poverty being a central factor. But to acknowledge that there are several blockages in the pipeline between better research and better patient outcomes does not logically render one important blockage less obstructive. 1. United Nations. December 2003. AIDS epidemic update. [United Nations Program on HIV/AIDS]. Accessed May 11, 2004. Available at http://www.unaids.org/en/default.asp 2. J. Borrell and J. Watal. May 2002. Impact of Patents on Access to HIV/AIDS Drugs in Developing Countries. [Harvard University Center for International Development Working Paper]. Cambridge: Harvard CID. Accessed May 11, 2004. Available at www2.cid.harvard.edu/cidwp/092.pdf 3. World Health Organization. April 2, 2004. WHO takes major steps to make HIV treatment accessible. [World Health Organization Press Release]. Accessed May 11, 2004. Available at www.who.int/mediacentre/releases/release28/en/