Keep taking the tablets
It is only a couple of months since the California-based charity AIDS Health Foundation was claiming a major victory in its battle to get big pharma to reduce the price of AIDS drugs in developing countries.
Leaving aside the ethical issues of drug pricing policies in the Third World, pharmaceutical manufacturers have always maintained that even if they gave the drugs away for nothing the situation would not improve noticeably because the infrastructure to deploy them effectively is not in place. This view has now been vindicated in a study carried out by the London School of Hygiene and Tropical Medicine and published recently in the British Medical Journal.
Indeed the unregulated supply of AIDS drugs could well be making matters worse by accelerating the development of drug-resistant strains of the virus. According to the study, uncontrolled prescribing of antiretroviral drugs is widespread and rising in Africa and Asia.
Author of the study, Dr Ruairi Brugha, says that often patients do not take their drugs as they should, while in some places patients are changing medication frequently, taking the wrong dose, or stopping treatment in periods when they cannot afford it. It is precisely these conditions that lead to a virus becoming drug resistant.
And the problem is not confined to the developing world: even in the rigid treatment patterns of the affluent west, HIV is becoming resistant to established antiretrovirals, the study says, and governments and health authorities cannot afford to wait for more dangerous resistance to emerge in the developing world.
Even the world's most advanced healthcare infrastructures cannot ensure patient compliance, a fact that is all too evident from the rising incidence of antibiotic-resistant infections in European hospitals. So when a prominent company such as Roche sets up a patient support initiative like that described on page 12, it can only be a positive move.
The more cynical might doubt whether Roche's motives are wholly altruistic - even though the drug manufacturer is meeting the costs of the service. But while higher sales of Xenical may result, the concomitant benefits of improved outcome for the patients and reduced long-term costs for the healthcare providers are surely enough to offset any vested interests.
It may be something of an exaggeration to say that obesity is as much of a scourge in the developed world as AIDS is in less developed countries, but it is proving to be an equally intractable problem. Furthermore, in the case of both diseases all the drugs in the world will only treat the symptoms. To address the root cause a change in lifestyle is necessary and that is simply not available on prescription.