Troubling pattern

April 14, 2004

FOR DR. LULU Oguda, an African physician treating HIV/AIDS patients in Malawi, the choice between holding out for name-brand medicines or using generic imitators available at less than half the price is easy.

"We are able to treat two or three people rather than one with every $500 to $600 we allocate for the program," she told a Senate subcommittee last week. What's more, she said, the generic combinations are easier to take - two pills a day instead of six - improving chances that none will be missed.

But the Bush administration says the risk of endangering patients by giving them foreign-made drugs not subject to U.S. safeguards for quality, safety and effectiveness makes the issue far more complicated. The combination pills made in India and South Africa have been approved by the World Health Organization, but that's not good enough.

Thus, AIDS relief money from the United States, which is the major international donor, will be spent only on brand-name pharmaceuticals until some regulatory means is developed to determine generic imitators won't do more harm than good.

That doesn't sound unreasonable. And if such a structure is put in place by fall, as promised, and immediately begins speeding relief to the millions in need of anti-retroviral medicine, a bit of caution might serve them well.

But any further foot-dragging will confirm suspicions that the administration is simply doing the bidding - as it has so often before - of the powerful U.S. pharmaceutical industry, which sees its fat profits increasingly under threat from foreign competitors.

Critics speculate that the administration's resistance to endorsing the use of foreign generics to treat AIDS overseas may actually be a skirmish in the domestic political battle over importing low-cost U.S.-made drugs from Canada.

Against mounting pressure from Congress and state leaders, the administration won't move to curb drug prices in this country and opposes imports on the grounds that it can't guarantee their safety, quality and effectiveness. The pattern looks familiar.

Meanwhile, bickering over drug approvals is contributing to a disheartening delay in an international AIDS offensive that after three years is providing lifesaving medicines to less than 10 percent of the 3 million poor people who need them.

Further, it's tainting one Mr. Bush's most ambitious and widely praised initiatives. In announcing his drive to provide drug medicine to 2 million HIV/AIDS patients in 15 nations in Africa and the Caribbean, the president said, "Seldom has history offered a greater opportunity to do so much for so many."

Fourteen months later, the opportunity remains almost as great. Nothing should be allowed to slow the mission down.

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