never think of never

Right now, I really should be on the road, heading home, meeting up with two friends. But I am far too wired at the moment. I have wanted someone to kick me in the shins and tell me how it is, and let's just say I am buckled just now. Sure, it is lovely to have supportive friends, to have people around you who are encouraging and hyperbolically positive about you. And sure, you want to show friends the size nine's when they are negative and unsupportive and counterproductive. But, usually, what you really need in this situation is unbiased, straight talk. Though it cost me about two benjamins, that's just what I got. Now I have my decision to make, but I have a much clearer picture.

All I want to do is go home and process. I have this fantasy of sitting in a spare room, in a spare chair, just thinking. But all I have is a cluttered one-bedroom, and dinner plans, so it is time for a little reality.

There's an interesting, and surprisingly even-handed perspective in NEJM (paid registration required, I believe) on antiretroviral therapy in India and the impact of recent patent law reform in India on the availability of low-cost generic drugs. I have always developed a headache when thinking through the whole issue of generic drugs. Yes, drugs should be cheaper, and yes, in the US, when a drug is off patent, by all means the generic should be readily available and extremely low cost. (start rant) Which reminds me- some generic drug companies must be making a boatload off of loratadine (previously known as Claritin)- that sh*t is still far too expensive, even in the generic form, for someone to relieve themselves of the sniffles. (/end rant)

But when you start considering the implications of low cost generics in other countries, it gets rather complicated. Some countries don't observe patent laws, some don't have as lengthy an expiry, some just don't police it. India is a good model. The country has the brain power, infrastructure, and resources to make generic drugs reliably, and at low cost. Previously, generic pharmaceutical companies in India did not really have to worry about patent issues.

I can see how that is problematic. If Indian companies are supplying generic drugs at low cost, prior to patent expirations, pharmaceutical companies start to lose their incentive to ever develop new therapies. The beauty of the business plan of the generic drug is that the research and development has already been taken care of. So, it's all the profit, with none of the cost. That means the pharmaceutical companies, in turn, take all the cost, and significantly less profit. Aaaand there's that headache I mentioned earlier, right on cue.

That's why I was particularly comforted by this dose of sanity from the NEJM article:

"The risks posed by the TRIPs legislation to HIV-infected persons in resource-limited countries cannot be ignored, but there are solutions to this apparent conundrum. The simple fact is that we need to have it both ways. We need to encourage quality-controlled manufacturing of generic versions of current and future antiretroviral agents, since this has proved to be the most efficient way to provide large-scale treatment at hugely discounted prices. At the same time, we need to provide incentives for major pharmaceutical companies to continue to develop antiretroviral drugs for the long-term benefit of HIV-infected people globally. Protection of intellectual-property rights and tiered pricing arrangements are key elements in maintaining this commitment.

Although this paradox may seem insurmountable, there are already indications that solutions can be found. For example, some pharmaceutical firms, such as GlaxoSmithKline and Gilead, have recently made licensing arrangements with generic-drug manufacturers such as Aspen. The Food and Drug Administration has approved, under PEPFAR, several generic antiretroviral preparations for purchase and use outside the United States. Imaginative strategies focused on the long term will be needed if we are to fulfill our obligations, and solutions will require brand-name and generic pharmaceuticals to coexist and prosper. Good economic policy, in this instance, can mean equally good public health policy."

Maybe for a change, everyone can win, albeit by less of a margin.

On a completely different note, is Heart's Magic Man considered cheesy? It's hard to keep track anymore. SP tells me you can listen to all kinds of cheesy music while remaining hip as long as you "listen to it ironically." Sadly, I am so tragically unhip, I don't even understand what that means. Something about Magic Man amuses me, and yet feels me with a sense of empowerment. Which is weird, since it seems like it might be about a guy taking advantage of a significantly younger girl (or it's about drugs- because it seems like every time I think I know what a song is about, I find out it's actually about drugs). I think it's the guitar, and the naked feeling of some of the lyrics. Pretty progressive for two women, given the age. Nowadays, I guess Lil' Kim would call them a bunch of uptight conservatives.

If you really read this post, you could see that I am a perfect embodiment of why a blog is a bad thing. I need an editor to keep me even vaguely on topic. Any volunteers?