Secondary Logo

Journal Logo

Notes And Quotes

Notes and Quotes

Susman, Ed

  • Free

COPE Guidelines

The guidelines on good publication practice produced by the Committee on Publication Ethics (COPE) are reproduced alongside the Guidance for Authors at the end of this issue. The acceptance of these guidelines by the Editors illustrates the efforts to maintain the ethical and moral standards of papers published in the journal. COPE ( has recently announced formal links with the World Association of Medical Editors (WAME, http://www.wame. com/) and plans to share experiences in handling of misconduct cases and other ethical issues.

AIDS conference world treatment

CHICAGO– The irony of the worldwide AIDS epidemic is that the drugs to treat the disease are in the North and the patients are in the South.

To correct the imbalance, a leading economist said the answer lies in massive help from the rich nations of the world so that the poorer nations can provide highly active antiretroviral therapy to the millions of people who often not only have nothing with which to treat HIV infection, but nothing to treat the opportunistic infections that follow.

And, besides being the right thing to do, Dr. Jeffrey Sachs, PhD, a professor of economics at the Harvard University Center for International. Development, Cambridge, Mass., said the wealthy nations of the world have a lot to gain by keeping populations in Africa and Asia healthy. Sachs said AIDS is destroying the teachers, the future leaders and the economic middle class, creating millions of orphans and the seeds of instability that can have worldwide repercussions.

More importantly, Sachs said the solution would cost about US$5 a person a year from the 1000 million people who live in the rich nations of North America, Europe and Asia.

Sachs said such a contribution would allow treatment of most of the 35 million people living with HIV – 90 percent of whom live in the poorest nations.

In a keynote address to the Eighth Conference on Retroviruses and Opportunistic Infections in Chicago, Sachs said that while the situation in the developing world – and especially in Africa – is bleak, ‘‘It is quite easy to do something about it.’'

However, Sachs said that in the past, ‘‘. . .from epidemiological, medical, and humanitarian points of view, the international response to the HIV/AIDS pandemic in the developing world has been utterly inadequate.’'

`‘The heaviest burden of HIV/AIDS lies in the world's poorest countries, where impoverishment and bankruptcy of governments mean that financial resources are unavailable to control the pandemic. The international donors, including rich-country governments and international agencies, have so far failed to mobilize adequate financial resources to assist the impoverished countries.’'

Sachs threw down the gauntlet at the threshold of the World Bank. Immediately, he said, the World Bank should initiate large clinical trials in two or three countries in Africa to determine the feasibility of providing HAART therapy to these people.

Combination therapy can cost a patient in the United States $10 000 or more a year, but Sachs said that drug companies could produce the medications for distribution in developing countries for much less – possibly for as little as $500 a year.

Companies shouldn't balk at providing the drug for cost in Africa, contended Dr. Anne-Valerie Kaninda, MD, Medicins Sans Frontieres, New York. ‘‘No pharmaceutical company in the world depends on profits from selling drugs in Africa’', she said in the closing symposium of the retrovirus meeting.

Sachs said that once those trials prove that the drugs can be delivered to patients who are ill, that the drugs will not be diverted to a black market and sold to patients in the rich countries at reduced costs, that the drugs can be safely and appropriately administered, and that they work to dramatically reduce AIDS death rates, then governments and pharmaceutical companies should work together to provide drugs at cost to everyone suffering from the disease.

`‘It would take a vanishingly small amount of money to provide this treatment’’ Sachs said, but he said it would require the leadership of the new administration of American President George W. Bush to make the plan work. Sachs said he has seen hints that the administration is interested in participating.

Sachs said that his talks with representatives of pharmaceutical companies indicate that the drug firms are anxious to get involved in the program, instead of taking countries such as South Africa and Brazil to court over production of generic AIDS drugs.

`‘Rather than have a war over this,’’ he said, ‘‘I would rather have an agreement. We would all be better off if we agreed in principle that the intellectual property rights could be respected but also accommodate the needs of the poor people – by providing drugs at cost – within the system.’'

`‘I find it quite horrendous for drug companies to be going after Brazil,’’ he said, ‘‘and I think for drug companies, from a public relations point, it is non-sensical for them to be suing South Africa. They will put themselves in the worst possible circumstances.’'

`‘The problem is they cannot make a deal by themselves and if the US government does not lead we are going to end up in an unfortunate and tragic situation’’ he said. ‘‘This requires that President Bush get interested in this and get interested in this fast.’'

`‘No matter what people say about the feasibility of it,’’ said Dr. Kevin DeCock, MD, director of the US government's Centers for Disease Control and Prevention programs in Kenya, ‘‘we cannot stay away from the issue of antiretroviral therapy in developing countries.’'

`‘The world's response to this epidemic has been astonishingly small compared to the magnitude of the problem. This is the greatest catastrophe in Africa since the slave trade’’ DeCock said. ‘‘It is untenable that the situation continue in Africa.’'

`‘We are our brother's keepers’’ said Dr. Kathleen Squires, MD, associate professor of medicine at the University of Southern California. ‘‘We can't live our lives as if we don't have a responsibility to less fortunate societies. We are a global society and we can't hide behind national boundaries.’'

Websites of interest:

Eighth Conference on Retroviruses and Opportunistic Infections

Medicins Sans Frontieres (Doctors Without Borders)

Center for International Development at Harvard University

© 2001 Lippincott Williams & Wilkins, Inc.