Public health and company wealth

Introduction

Millions of people in the developing world are dying because they cannot access the medicines they need. This made international headlines during the World Trade Organisation's meeting in Seattle in December 1999.1 The high price of AIDS drugs became a banner of the world's iniquities: on one side of the globe, Western multinationals made billions of dollars; on the other side, millions of people suffered and died of treatable infectious diseases. For decades the pharmaceutical industry was the Golden Boy of Wall Street. By the end of the 1990s it began to acquire a new reputation, featuring as the villain of spy novels (like John Le Carre's The Constant Gardener2) and Hollywood blockbusters (like Mission Impossible II). The industry has responded to growing public criticism by reducing some drug prices for some countries. From company boardrooms, it might seem that many sacrifices have been made. But few patients in developing countries are aware of these efforts. Progress in reducing drug prices has depended mostly on market competition …