The following article is an edited transcript of the Opening Address of the International Conference on Compulsory Licensing: Innovation and Access for All, held in Bangkok, 21-23 November 2007, organized with the collaboration of the Health Consumer Protection Programme of Chulalongkorn University with the support of the National Health Security Office and the Thai Health Promotion Foundation.  Further papers from the Conference will be posted in Prachatai as they become available. 

When the American astronaut Edgar Mitchell was standing on the moon and looked at the entire earth in totality, his mind completely changed.  He said, ‘I came back to earth a totally changed man'.  After being aware of the same oneness of the planet, his consciousness changed.  He developed compassion to all mankind and all the environment and nature, because all belongs same to this oneness.   

We face very complex and difficult issues and we will need a new consciousness to be able to cope with difficulty of the issues.  What we are dealing with is a very complex ethic of human values and policies.  Advancements in science and technology on the one hand have brought about wonderful diagnostic and therapeutic tools, the benefits of which no one can deny.  But on other hand, advanced science and technology lead to products and methods which are very expensive, and this causes problems of inequity.  This outstanding problem has been with us for at least 4 or 5 decades. 30 yrs ago I participated in a Rockefeller meeting in Boston and talked about this issue of inadequate investment in research in diseases of the poor because they do not have the ability to pay.  So research investment goes into diseases of rich.   

So first of all, what can be done about inadequate research on diseases of the poor, because when technology, such as vaccines or drugs, is developed, the poor cannot afford to pay?  Secondly, when technology is available, it is expensive and not accessible to the poor.  This happens not only in developing countries but even in the US.  The US spends 12-14% of GDP on health, the highest proportion in the world, and much, much higher than other countries, both in terms of percentage and in real terms.  Yet about 40 million Americans are without health insurance of any kind, and they cannot afford to go to the hospital because it is too expensive.  When Bill Clinton was running for the presidency the first time, he promised that if elected, he would reform health care in America.  And he did try, appointing Hillary Clinton as chair, with the Minister of Public Health and other experts to try to reform it,  but they failed.  You can see how difficult it is.  The proposed reform met with resistance and opposition from various sectors.  Now Hillary Clinton is trying again, running for president and talking about health care reform, but in a modified form.  So these are the outstanding problems; inadequate research for the poor and when technology is available it is not accessible to the poor.  What can be done about this?  It is very difficult.  I think people are trying to find solutions to this.  The Prince Mahidol Award Foundation early this year, together with the WHO in Geneva, organized a meeting in Bangkok, attended by the Director-General of the WHO, Margaret Chan.  And the theme of the international conference here was this topic: How to make useful technology accessible for the poor.  There was a lot of discussion and many recommendations from the conference.   

To begin, I think we have to understand the complex drug system: drug development, the manufacture and commercialization of drugs. It is a very complex system and no one understands it.  What we know is what the drug companies tell us.  They tell us that drugs have to be expensive, because drug companies invest so much in research.  That's all we know and what can we do if we know only that, because in modern society there are many complex issues?  If we are in darkness, we don't understand the elements of complexity.  We don't know how to deal with it.  It is very important to unfold complexity into its components so people can do something about it.  Dr Marcia Angel, the former editor of the New England Journal of Medicine wrote a book, ‘The Truth about Drug Companies and How They Deceive Us'.  She found that what the drug companies tell us is not true. 

1. The main research that leads to drug development is carried out in universities paid for by the taxpayer not drug companies - the drug companies come in only towards the end of the pipeline.  But a lot of basic research, clinical research, epidemiological research, pathology research, molecular biology, and so on, which finally leads to drug development, is done in the universities, using taxpayers' money. So it's not true that drug companies invest so much in research for drug development.

2. Excessive profit. The figure I knew when Clinton was campaigning for health care reform in America was 27% of assets, which is far too high, higher than in other businesses.  Why make so much profit from the blood, illness and death of people in America?  The Clinton group called it blood money.

3. The CEOs of drug companies have incomes that are too high. The book cites one CEO who earned $150m per year.  Why so much?  When the poor cannot pay, why does the CEO have to earn $150m per year?

4. Drug companies lobby politicians to issue laws that favour the companies at the expense of the consumer to keep the price high.

5. Drug comp lobby on the appointment of the Secretary-General of the FDA.

6. The American people, because drugs in America are so expensive and the same drugs just across the border in Canada are much cheaper, want to buy drugs from Canada. And drug companies lobby politicians to issue laws or regulations to prohibit Americans from buying cheaper drugs from Canada.
   

This kind of truth I think we have to know.  It is a role for the academics in the universities.  I would like to urge them to understand the drug system. In Thailand we have a lot of PhDs in various faculties of pharmacy.  But they have technical knowledge; most of them do not understand the drug system.  There is a need to get these academics interested in doing research on the drug system, so that they understand the complexity and the components of the complexity so that the public can deal with it.  Otherwise we only know from the drug companies that drugs have to be expensive, because they have to invest a lot in research.  This is a strong message to the academics that we have to do more. 

This conference will be dealing with CL or compulsory licensing.  On the one hand compulsory licensing brings about lower prices of drugs and can save millions of lives in the developing countries. But on the other hand, it will lead to a reduction in the profits of shareholders in drug companies.  And it is very difficult to ask shareholders to reduce their profits when they live in a different world. The poor and the sick live in one world and the shareholders live in another world. They don't understand this.  This is the issue that we will be dealing with, how to innovate and find ways and means to make drugs more accessible to the poor; how to deal with the funding of research, how to work with the government on policy.  So there are technicalities to do with finance, policy and the many sectors involved here.  Governments, drug companies, academics, civil society and the poor and the patients themselves are working on this.   

The present world economic system is driven by greed. Maximum profit is the goal of economic development.  So we should have to ask the critical question whether, for human development, maximum profit should be the goal of mankind, or living together peacefully among mankind or between man and the environment.  I believe that we have to change the goal of mankind from making maximum profit to living together.  Living together should be the supreme goal of humanity or summum bonum of mankind.  We cannot talk about maximum profit alone. But of course we don't expect drug companies to lose money or not make profits.  That is not possible.  But should maximum profit be the goal?  To deal with this difficult issue of cost we have to deal with technicalities of law, finance, policy, and so on.  But it may not be adequate because the world crisis now is so great.   

Ervin Laszlo, Stan Grof and Peter Russell spent two days and two nights in California on the rim of the Pacific talking about world issues and they came to the conclusion that the present civilization will inevitably lead the world into a great crisis.  They use the term ‘consciousness revolution' that can bring man out of the present crisis.  The Dalai Lama said that the present crisis is a spiritual crisis.  There's a need for a spiritual revolution.  Albert Einstein once said we shall need a radically new manner of thinking if mankind is to survive.  If we continue with same worldview, the same thinking, mankind may not survive.  I believe that the world is too sick from the great divide between the haves and have-nots.  The crisis is so great we have to work to heal the world.  I would suggest that we use this opportunity for working toward making drugs accessible to the poor, to change our consciousness, change our manner of thinking to heal ourselves and heal the world.