I don’t believe we’ve met before but I think I can call you Martin as working with people living with HIV I have found it’s common decency to remember their names and address them directly. Also, I need to give you some personal advice: this whole putting up the cost of Daraprim may have seemed a good idea at the time, but in the words of one seriously divisive feminist: big mistake, huge.
If there is one feel-good story in global health politics it is that of AIDS activism. Simply put you’ve picked the wrong disease to mess with. AIDS treatment is one of the most emotionally-stirring diseases of our time. This emotion is linked to injustice in the lack of attention and care and abundance of stigma towards people living with HIV/AIDS in the late 1970s and early 1980s; the fight to demand treatment as a human right and the commitment of people living with HIV, volunteers and activists to make this an accepted norm in global health; the takedown of a government in South Africa for AIDS denialism; and of course the piece de resistance: the failure of 39 pharmaceutical companies to bring a lawsuit against the government of South Africa, or as one pharmaceutical insider once told me ‘the time big pharma decided to sue Nelson Mandela.’ In case you haven’t already Martin, I would cue up We Were Here, Fire in the Blood, and How to Fight a Plague for your next Netflix session.
I don’t mean to be mean, but in comparison you’re small fry dude. The AIDS community have been looking for something or someone to assemble around and my guess is you are currently target number one. Do you really want to take on the activists who challenged Ronald Reagan, got the WTO to change its rules (the WTO people!), discredited a whole government (just google Mbeki if you don’t believe me), and generally acted in a badass way to suggest that accessing treatment is a human right? Trust me on this one, I don’t think you do.
And then there’s the whole humanity part. Sure, you provide the drugs to keep people alive so we should really send you more kisses. But guess again. How much money do you really need? And I mean need rather than want. And how good does it feel to price people out of treatment and push up their insurance premiums? Have you ever cared for someone living with HIV/AIDS who is unable to access treatment? If you have I am sure you will know how difficult it is to give them peace, dignity and to alleviate their concerns about the stigma they face, often from their family and community. Perhaps you also know women who contracted HIV from their husbands, who were unable to negotiate safe sex to protect themselves and their future children, and have to balance their work, family and treatment in the midst of social stigma. I think we both know that without affordable and accessible treatment they would not be alive and would transmit the virus to their children. I think we can also both agree that’s a major bummer Martin.
But then again, I get the impression that you care less for the humanity aspects of this whole treatment shebang. I note from your tweet you’ve given money away to good causes, but come on Martin, everyone knows that someone who tweets about their good deeds is generally a bad guy. The pharmaceutical industry is worth billions so why shouldn’t a young-buck like you get a slice of the pie, am I right ladies? Now I am not a financial wizard but let’s consider two things: your competition and your customer. On the competition, you are competing with multiple producers of HIV-related treatments from around the world. Indian companies are really going to screw you on this. True, it is harder for these companies to access the US market, but if we’re talking AIDS treatment then really think about the pool of 24.7 million people living with HIV/AIDS in sub-Saharan Africa. I know you’re greedy (who else would increase the price of a drug by 5000%) so you must be thinking about this market. But let’s think about the average customer: HIV/AIDS affects all different types of people and the one thing the global AIDS response doesn’t need is another stereotype, but to give you a basic idea your customer base is most likely to be a woman living on less than $2 a day. Less than $2 a day Martin – I’m guessing that is less than the coffee you’re drinking right now. In some ways they are your perfect customer: they have the virus (tick!), have less links with annoying journalists (double tick!), and most likely are not smartphone addicts that will tweet the heck out of this (triple tick!). But of course, the killer problem is ability to pay. The US government has poured money into helping these women access treatment (not without controversy) but most development assistance for HIV/AIDS has begun to decline and there are questions over who fits the bill. This basically means no-one in sub-Saharan Africa – your main customer base – will buy your goods. No-one in South America will buy your goods as they have developed a wiley system of bulk-buying that has helped keep costs low (ish). So really, you’re only left with screwing over your friends in the US – those with Twitter accounts, links to journalists, and resources to mobilise against you – and as I noted before, this is not going to end well for you Martin. You will not win.
You’ll note I have raised a serious of questions in this blog, and I really hope you write back to me. I’ve been looking for a pen friend. And for purely selfish reasons I’m making a film on the everyday risk of accessing treatment and care for women living with HIV in Tanzania and think a scene of you explaining your price-point tactics to these women would be cinema gold. I hope you listen to some of my advice Martin because this really isn’t going to end well for you.