Introduction: Ethical Responsibilities Regarding Drugs, Patents, and Health

HIV/AIDS threatens international health on a scale never before seen in human history. Previous plagues and great epidemics, devastating though they were to imperial China, urbanizing Europe, and the colonizing Americas (McNeill 1998), were regionally contained. More than forty million people worldwide are HIV-positive: about half of them live in sub-Saharan Africa, where it apparently originated and where whole tribes and, indeed, most of the adult population of Botswana may very well die of the disease. (Joint UN/WHO 2004). India has another five million people who are HIV-positive, the largest number outside Africa. AIDS is spreading rapidly in China and devastating Thailand, a regional center for prostitution that spreads it further throughout the Asia-Pacific region. No part of the world is spared. The economic, social, and political impacts of this pandemic have only begun to be felt and to be considered.Modern technological and organizational capacities—jet aircraft and globetrotting business and tourist travelers—turned what would have been, in previous eras, an African regional problem into an international crisis and made AIDS exceedingly difficult to contain. Yet, the human technological and organizational capacity to confront the AIDS pandemic also makes this health crisis different from epidemics in earlier times. Medical science applied by pharmacological research has created drug therapies that can control the disease, that can not only stave off death but make productive life possible for many years. The challenge of AIDS could be met, many in the health community say, if it were not that the life-sustaining drugs are owned by private enterprises (Oxfam 2002). The doctors at Médicins Sans Frontières contend, “Patents are not god-given rights. They are tools invented to benefit society as a whole, not to line the pockets of a handful of multinational pharmaceutical companies” (MSF 2003: 2). “[T]he patent monopoly means that a higher price than necessary has to be paid for patented inventions. This is acceptable if this higher price is merely an inconvenience…. However, if the patented invention is essential (say, if it could prevent your untimely death from disease), then the price is more of a dilemma” (MSF 2003: 5). These and other critics declare that drug makers put profits ahead of people and accuse the governments that grant them patent-intellectual property rights, especially the U.S. government, of contributing to this moral bankruptcy.