Surviving but Going Broke: The Affordability of AIDS Treatments (1989)

Spencer Michaels, a public station KQED, San Francisco, has this report. 41-year-old Dan Turner, a former typist, is the longest surviving AIDS patient of Dr. Paul Volberding, director of the AIDS clinic at San Francisco General Hospital. Turner started having symptoms of Kaposi's sarcoma in 1981. Just as AIDS was becoming known, and he was treated over the years with a wide range of drugs. I began by taking a vinblastine chemotherapy for four months, then I was one of the first ten people to do alpha interferon. I started AZT. I have also done acyclovir for herpes virus. I hope to start DDI, which does not suppress the bone marrow like AZT. Although Turner got many of his drugs free as part of clinical studies, AIDS treatment has still been expensive for him. Myself and most of my friends have are totally broke, and we don't have any money, so we do rely on the system to get these experimental drugs.

Those who have had an income and some type of savings have to pay for the drugs, and of course immediately lose their savings because of the high cost of the drug. It tends to be an expensive disease in that the patients often have multiple problems that require chronic drug therapy at the same time. It seems to me that in most diseases patients may require just as expensive a drug, but they need them for shorter period of time, and they don't usually require three or four or five drugs simultaneously, and AIDS that's not the case. Activists, most patients and doctors alike have zeroed in on this drug as one place where AIDS costs should be reduced. Labeled as retrovir, it is more commonly known as AZT, and it is the only drug approved by the FDA to slow the progress of the AIDS virus, HIV. New evidence shows that AZT is also effective in delaying the onset of AIDS symptoms in patients with the virus.

A year's supply of AZT at first cost $10,000, then it dropped to $8,000, and in mid-September its manufacturer, Burroughs Welcome, reduced the price to $6,400, or $1.20 per pill. With 43,000 Americans currently stricken with AIDS and at least a million others carrying the virus, the potential market for AZT is enormous, and so are the potential profits for Burroughs Welcome. They cut costs by 20%, clearly a step in the right direction, there's no question about that. Pat Christian is executive director of the San Francisco AIDS Foundation, an educational and political group which lobbied to get the price of AZT reduced. They are entitled to earning a fair profit, but the issue here is what is a fair profit, and I would argue that billions of dollars carried on the backs of people with AIDS in this country is not a fair profit. Another group of AIDS activists ACT UP, took more direct action. They vented their wrath at the drug industry by disrupting the New York and Pacific Coast

stock exchanges. ACT UP member Michelle Roland says militant activists are having an impact in reducing drug costs, although she says the price is still too high. People don't always like what ACT UP does, and that's okay. What ACT UP does is it raises the issues, and it makes people think about the issues. Unfortunately, they often focus on the techniques, and they'll say, gee, we don't like it that they've chained themselves to the stock exchange, but now they're talking about the price of AZT, and they're looking at a national health care crisis. Whether they felt that this was a causal or fortuitous association between their activism and our lowering the price is really their opinion, there's no question, however, that it was relayed, that it followed a very long and very careful calculations of what we believe the appropriate price would be, so that we could continue to have the return needed to fund our very innovative research program.

Dr. David Barry is Vice President for Research for Burroughs Welcome, the British-owned firm that manufactures AZT in North Carolina. Burroughs Welcome has defended its pricing of the drug, explaining that research and development costs, including clinical trials, are high. The elements that go into deciding the cost of a drug include not only its cost of manufacture, but the number of patients taking the drug, how long they take it, what dose they take it in, and what our expected needs for continuing research are. But AIDS activists point out that AZT was synthesized in 1964 by a cancer researcher working on a government grant, and not by Burroughs Welcome. They were not involved in the early development, they were certainly involved in the development and testing of the drug as it relates very specifically to HIV infection in AIDS, however, as a company, they stand to make billion dollars or more off of this drug, their costs surely were not anywhere near a billion dollars, so for them to say that they have to

continue charging these extraordinary prices because they have to cover their costs is now a vacant argument. There's no basis in it. I think it's inappropriate and would lead to false and misleading conclusions if one tried to say, well, how much money do you make on an individual drug? Because they don't answer the question, how much money do you lose on the 10 sometimes hundreds of drugs that are complete failures? I have to point out that in developing drugs for diseases that are yet to be treatable, failures are far more common than successes, and that the failures never pay for themselves. The successes have to pay for the failures.