February 25, 2002

6:51 PM

The NIH is abandoning phase III trials of a possible hiv vaccine due to "technical reasons" the trial will continue in thailand. On a happier note there are currently more than 90 other hiv vaccines in other stages of trials. What do people think are the chances the pharmaceuticals will decide chronic disease management is more profitable, and actually do something to make this a more likely outcome?
posted by rhyax (21 comments total)

Uh, I think the drug companies currently think chronic disease management is more profitable. That's why billions are spent on HIV treatments, and little has been spent on a vaccine. Drug companies aren't interested in helping people (or if they're are, it's only an unintended side effect). They're interested in what every other company is interested in--profit. Making money. If a vaccine is ever successful, it will be because some benefactor or government paid for the research.
posted by gramcracker at 7:04 PM on February 25, 2002

I've often wondered if it all would have turned out differently if the method of transmission for HIV was airborne, like the common cold. Just as there are people who don't 'feel sorry' for smokers who get lung cancer, there are those who from the beginning have felt that people who won't conform to the mores of the 'moral majority' get whatever they deserve. Unfortunatly, there are a lot of those uptight moralizers out there and they know how to concentrate power.
I believe a vaccine will be perfected, as it was for polio and smallpox and others, by the pharm. companies themselves. Then something worse than aids will occupy their time.
posted by Mack Twain at 7:50 PM on February 25, 2002

I've heard this hundreds of times, usually it's cancer. I remember an article (damn I wish I could find it) that said that said the actual researchers could care less how much a drug makes, plus the higherups all said the same "I would feel better if my job was obsolete", and I believe them. Do you really know of anyone that cruel to hold back a drug vaccine? Now do you know a thousand people working in unison to hold it back? Vaccines are profitable too. Plus, look at all the diseases that they created vaccines for (Chicken Pox, Influenza) when the drug treatment for these common modern, non-life threatening diseases would be more profitable than a vaccine.
posted by geoff. at 8:10 PM on February 25, 2002

"I've often wondered if it all would have turned out differently if the method of transmission for HIV was airborne..." Actually if AIDS was airborne I think we'd all be dead by now.
posted by ZachsMind at 8:36 PM on February 25, 2002

Geoff is right. I'm an HIV-1 researcher, and although I work on basic biology and drug discovery rather than a vaccine I assure you it is always in my mind that I am trying to put myself out of a job. Nothing would make us (HIV researchers) happier. (We won't be out of a job, natch, we will just find other things to work on.) I simply cannot imagine that a vaccine, if an effective one were worked up, could be kept from the public: there'd be no way to shut the research team up! Once it was public knowledge, there would be no alternative but to develop and supply it.

[Brief aside: I think it is widely accepted (and it is certainly my view) that the long term solution to HIV-1 probably lies in a vaccine; in the meantime, there are millions of people infected whose lives can be greatly improved and lengthened by improvements on currently available drugs. Hence my occupation.]
posted by sennoma at 8:44 PM on February 25, 2002

Given the referenced number of 90 different vaccines in trial, as well as basic economics, I find it powerfully hard to believe that vaccines are unlikely to emerge from the marketplace. While management, in the abstract, is likely to be more profitable than cure, it's also true that only a few companies actually profit from this management. Should Merck release a management drug, certainly Pfizer may work to release a better one, but I find it quite likely that one of the multitudes of biotech companies will find it far more profitable to develop and market a vaccine that to market a slightly better management drug.

Regarding the AIDS moralizers. AIDS is one of those interesting afflictions which is, in theory, almost entirely avoidable. Now, that those who refer to it as a plague upon a homsexual nation, or as just desserts for premarital sex are full of it probably doesn't need to be discussed in any great detail. However, I suspect plenty of "moralizers" are driven more by, shall we say, issues of policy rather than an actual lack of sympathy. That is, nearly everyone would sympathize with those with lung cancer or AIDS and agree that they are tragic and painful afflictions. But they would probably also agree that someone who ate well, exercised, etc. and still had a fatal heart attack at 40 is worthy of more sympathy. And while you never really want to start quantifying sympathy, this suggests that perhaps federal funding priorities should be determined by the "avoidability" of the disease, rather than the nature of it.

So, point being, I don't think a lot of the moralizers really mean it. It's an asshole thing to say that you have no sympathy for someone whose suffering to that degree, I just think a great deal of people make these statements while trying to push responsibility than out of a deep-seated callousness.
posted by apostasy at 8:49 PM on February 25, 2002

It's a classic example of the prisoners' dilemma. True, they would all benefit from not making a vaccine, but they'll still do it because they can't be sure that the others won't.
posted by cx at 8:54 PM on February 25, 2002

I'm not saying drug makers hold back a vaccine, geoff, I'm saying they don't focus on them (PDF). They focus on treatment, which makes a lot more money (drug cocktail every week vs one-time vaccine).

And yes, I do think people would put profits ahead of health. What do you think for-profit hospitals and health care organizations do? Enron executives put their own profits and greed ahead of the financial security of their investors and their employees. Is there something that would make drug execs any different?

I'm not saying everyone working for the drug companies are evil corporate hogs (no offense to you, sennoma), but drug companies for the last 20 years haven't focused on vaccines. They've focused on treatments.

If they honestly, truly cared about helping people--and specifically those people with HIV or AIDS, they would live modestly, and give the millions they make each year to help people--or lower the costs of their drugs. Hell, form a non-profit that invests all its profits back into research, or into communities that need the most help.
posted by gramcracker at 9:20 PM on February 25, 2002

> If they honestly, truly cared about helping people ...

Do you honestly, truly care about helping people?
posted by sylloge at 9:46 PM on February 25, 2002

Not all vaccines are "one-time" things. As someone who's been vaccinated for Hepatitis C, it was a coarse of vaccinations over period of a year. Flu vaccines? Aren't these annual? The rusty-nail syndome? Isn't that every 5 years or so?
posted by G_Ask at 9:57 PM on February 25, 2002

Sorry. Rusty nail syndrome = tetanus.
my computer is on the fritz and the only thing that works is Metafilter. No search engine, no spellcheck. I'm in hell.
posted by G_Ask at 9:59 PM on February 25, 2002

No, you're right, G_Ask. They're not always one-time cures. I shouldn't have generalized. (But they're still generally less-frequent than treatment meds.)

sylloge:
I'd like to think I do care about people. Honestly, truly. But I didn't think the focus was on me, here. I thought it was on the philanthropic drug execs that are trying to help people by bringing in huge salaries, charging almost-unaffordable prices for their medications, spending millions on advertising campaigns, and wooing physicians with lavish dinners and other perks.
posted by gramcracker at 10:03 PM on February 25, 2002

Damn. None of these links work for me. Perhaps people will add better statistics than the ones I will throw out.
Is it really more profitable to treat long-term (10 yrs average?) 1% of the population than to vaccinate 99% ?
Taking into account rough estimated of people (newborns, whatever) that would be eligible for vaccinations v. small group of HIV+ and limited life expectancy.
posted by G_Ask at 10:23 PM on February 25, 2002

Do you really know of anyone that cruel to hold back a drug vaccine?

Pharmaceuticals spend much more money on advertising than on research. If the companies spent even 10% more on AIDS research, we'd probably be 10% closer to a cure. Meanwhile, they're making a killing on maintenance drugs.

If and when a cure is found, will the company try to capitalize off of it as much as possible? Will it abuse patent laws, create variable pricing schemes, and wield international trade restrictions and its cozy relationship with the US government to impose sanctions on countries that dare produce the drugs themselves? Or will the company release it to the world, as a gift to humanity?
posted by panopticon at 10:27 PM on February 25, 2002

Once it creates the vaccine, doesn't it have a limited lifespan thanks to patents?

Perfecting drug cocktails the rest of your life is more cost effective than giving away the secret to the cure. You'd only have seven to ten years to make money off the cure, then have to share it among a hundred other generic brands that would always undercut you.
posted by witchycal at 10:59 PM on February 25, 2002

i basically agree with the general sentiment here--it would be great if the pharma companies would be less profit-driven and would target their research with more of a social agenda in mind. that would be great.

but it's not going to happen. moreover, the government can't really force pharmaceutical companies to focus on vaccines against aids and malaria. nor should they, really. whatever you might dislike about pharma companies (and there's a lot to dislike), they're really good at discovering new therapeutic agents when they put their mind to it. take away their profit motive and you take away their incentive to develop medicines that, let's face it, save lots of lives.

the part of the equation we're leaving out here is publically funded academic research. all of the chemists and biologists who perform the research at pharmaceutical companies are trained in academic labs. we reserachers in universities are just as skilled as our industrial counterparts; we're just massively underfunded in comparison. so if you really believe that finding an anti-hiv vaccine is a matter of vital national interest (and i believe it is), use your voice to encourage the government to invest more public funds into the effort.

btw: what were these "technical reasons" for cancelling the phase iii trials? anyone know?
posted by shylock at 12:50 AM on February 26, 2002

... and one post to black-helicopter conspiracy theories. Gramcracker wins the prize!

Did it ever frigging occur to you that perhaps a vaccine is a more difficult proposition than a treatment? Nah, best attribute to malice everything that doesn't fit your world view.

I got sick of this when I lived in New York during the 80s and on every mailbox was plastered a badly-xeroxed screed explaining how AIDS was invented at Ft. Detrick and Reagan had it introduced into the civilian population to control the black and gay population.

whup whup whup
posted by dhartung at 6:42 AM on February 26, 2002

Maybe my theory is a little crackpot, dhartung, I'll give you that, but I don't see how you can ignore the fact that much less money was (and still is) being spent on a vaccine. A vaccine might be more difficult, but would help a much larger portion of the population. And still, like the PDF above put it, "Hollywood spent more money making Titanic than the whole world is spending on developing an AIDS vaccine." You don't see something wrong with that?
posted by gramcracker at 7:41 AM on February 26, 2002

another thing to think about, if a vaccine does come out, i don't think the pharma companies will really be able to control a population that is unwilling to pay high fees and have people go without the vaccine that are at risk. remember what happened with cipro and anthrax, canada basically said screw patent laws, also i think brazil is currently disregarding some patents for hiv medication...

if a vaccine was released i'm not so sure the companies could count on the world population honoring it's patents.
posted by rhyax at 8:08 AM on February 26, 2002

Rhyax is right. Once a cure or treatment for a disease of this magnitude to created you can count on many countries automatically copying it.

There are a few issues I do not think people have examined:

(1) Insurance companies: Will they pay? Or would they rather see a terminally ill patient die? I have spoken to drug researchers who think that this is the case.

(2) The development of a vaccine is a tricky business. Finding the correctly attenuated virus that will work and is not affected by other virii or events is very difficult. Also, could there be a mutation of AIDS?

(3) Developing a drug candidate for a disease is a long, arduous process. In the US it takes an average of 15 years to develop a drug. Only five in 15,000 compounds enters preclinical testing. Only one of these five are approved.

I have much respect for people like Sennoma. These are the people who are out there trying to save lives.
posted by Stretch at 8:24 AM on February 26, 2002

If anyone cares, VaxGen is holding a conference call tomorrow regarding their AIDS vaccine trial.
posted by Stretch at 3:20 PM on February 26, 2002