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03 Mar 14 14 Dec 16

Opinion and debate: The Bangkok Buyers Club

Please note: Views expressed in this section are those of the author(s) alone and do NOT reflect the official position of Médecins Sans Frontières/Doctors Without Borders (MSF).

Paul Cawthorne
MSF Access Campaign Co-ordinator in Asia

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Last night at the 86th Academy Awards, 'Dallas Buyers Club' won three Oscars including the Best Actor gong for Matthew McConaughey. In the true-to-life story McConaughy plays Ron Woodroof, a man living with HIV, who was denied access to a trial testing anti-retroviral drugs. Incensed, Woodroof begins smuggling drugs to treat the disease - eventually setting up a ‘buyers club’ to treat friends also living with HIV.

The film presents this as a historical problem, confined to the 80s and 90s, but watching it, I was reminded of much more recent work. Back in 2000, when HIV was raging uncontrolled and untreated through developing countries, I was in charge of Médecins Sans Frontières/Doctors Without Borders’ (MSF) operations in Thailand.

The Ron Woodroof approach

We started one of MSF’s first HIV treatment programmes, but it wasn’t easy; back then, antiretroviral drugs cost around US$10,000 per person per year. Our solution? The Ron Woodroof approach.

Each of us in the project, along with other supporters of HIV treatment, took turns to hide as many of the antiretroviral drugs in our suitcases as we could on return trips from abroad; we were effectively smuggling people’s lifelines in.

But, as in the film, there wasn’t enough to go around.

It meant doctors had to ration the drugs and take hard decisions; who got treatment, who went without – and who inevitably died.

"Waiting means dying"

Today, nearly 10 million people in developing countries receive HIV treatment; MSF has also grown from that first project in Thailand and now treats more than 285,000 people in 21 countries.

Yet, we constantly have to fight for access to newer, more expensive medicines that can cost up to 15 times more than the basic drug cocktail.

And this problem isn’t limited to HIV. As many as 180 million people worldwide – the vast majority in developing countries – are infected with hepatitis C.

The cost of new drugs to treat this is simply staggering: one drug alone is US$84,000 for a 12-week course; an astronomical US$1,000 per pill.

Why are new medicines priced so high that even people in wealthy countries can’t afford them?

In the current research and development (R&D) system, patents on drugs are given to companies, usually for 20 years. Companies then charge the highest price the market can bear, without fear of competition. Patients and health providers are put in a near-impossible predicament: either they pay the market rate, or wait for 20 years. And waiting usually means dying.

Time to demand change

The current system also means some desperately needed drugs just don’t get developed at all. Until the end of 2012, there had been no new drug developed to treat tuberculosis (TB) for 50 years because it isn’t profitable: the vast majority of TB patients live in poor countries.

But this lack of research and development into areas of need is beginning to hurt people in wealthy countries, too.

We’re seeing people die of infections we can no longer treat with antibiotics, and there are no new drugs in the pipeline. Pharmaceutical companies don’t want to invest in R&D for drugs that people only take for a couple of weeks; they spend on drugs you need for a lifetime.

We need to develop a R&D system that does not choose between developing a drug or making it widely available.

This idea is nothing extraordinary. There are already alternatives, such as prize funds, that reward new discoveries with substantial financial payouts – on the condition the drug fills a need, and is immediately open to competition.

The current system is no longer fit for purpose. I live in Thailand and every day I see people hurt by it.

It is time to get angry and demand change. As Ron Woodroof did.

What do you think? Have your say and join the debate below