World AIDS Day: An opprtunity for physicians to shout "YES" for access to medicines, "NO" for access to our integrity

On World AIDS Day this year, we commemorate another embarrassing 365 days in which millions of persons with HIV/AIDS around the globe continue to lack access to the effective, life-saving medicines to treat their fatal disease. Not because the world can't afford it, and definitely not because the pharmaceutical companies are going bankrupt.

In fact, these companies continue to spend $15,000 to advertise to each practicing physicianin the U.S. in order to alter their prescribing behavior, toward more expensive, "me-too" medicines; this same amount of money could provide 50-150 AIDS patients a year's worth of drugs that could keep them alive. And despite the pharmaceutical industry's propaganda that they cannot afford to sell such medicines at affordable prices in thedeveloping world, consider this: over the past three decades, no U.S. industry has come close to achieving the profit margins of the makers of prescription drugs. Furthermore, only 11% of total sales for this industry come from the developing world, arguing against the sound bytes by PhRMA, the industry's lobbying group, that they would go broke in order to provide such treatments.

Recently, in a highly publicized case, Abbott Pharmaceuticalsdid the unthinkable and decided to take its drugs off the market in Thailand when the country made the decision to not honor the company's patent on an HIV/AIDS drug due to the medicine'sprhibitively high cost. But how does this connect to the free lunches and gifts given to doctors?

Daniel Carlat's recent NYT expose (Dr. Drug Rep, Nov. 25th 2007), an article in which he elaborates on the ways in which drug companies buy doctors who then pitch the company's products to their colleague physicians brings up many ethical and cost issues, but is there a connectionbetween this practice and the larger inequities we see in the access to essential, life-sustaining medicines globally?Yes, and it is quite simple - when doctors eat (literally) out of the hands of these pharmaceutical companies here at home, they are numbed into complacent non-action regarding the policies of these same companies abroad. Physicans and physicians-in-training must muster the moral and ethical willpower to shout, "YES" to access to medicines, "NO" to access to my integrity.

Physicians must tell these companies, who claim to be so fond of gift-giving, that we want to see HIV/AIDS patients served with life-saving medicines at affordable costs instead of having lavish lunches served in our clinics and hospitals. Until we can do this, wiping our chins and conscience from the bribes of the drug companies, we will not see physicians stand up to demand access to medicines for the world's most vulnerable.