Canadians are often frustrated by the high cost of many prescription drugs. But most of us have become used to the pharmaceutical industry rationalizing these outlandish prices by citing how much scientific research goes into creating new medications.
Film director Dylan Mohan Gray wants to puncture this perception. And he’s uniquely qualified to do so: he grew up in Canada, paid whopping fees for pills in this country, and saw how little the same drugs cost in Mumbai, where he’s been living for the past nine years.
In a phone interview from New York, Gray describes how he paid $120 for 20 tablets of a stomach medication called Omeprazole in Nova Scotia. He later bought 40 tablets of the same drug in Mumbai for $1.
“You’re talking a price differential of 240 times,” he says. “This is an off-patent drug. And the Indian company that’s selling it is making a healthy profit. It’s not a charitable organization.”
The impact of these price markups has been deadly to millions of Africans with HIV/AIDS. Gray’s documentary, Fire in the Blood, tells the story of a dedicated group, including former U.S. president Bill Clinton, who shattered Big Pharma’s stranglehold on the continent in the late 1990s and early 2000s—a crisis that Gray characterizes as the “crime of the century”.
“Drugs are not complicated and expensive to produce,” he insists. “They’re not even that complicated to develop, generally speaking. There are millions or even billions of dollars spent on them. Compared to the revenues that the companies are making, it’s a drop in the bucket.”
Near the start of the film, a Supreme Court of South Africa justice with HIV, Edwin Cameron, explains that he’s alive because of the discovery of combination therapy in the mid 1990s. Treatments cost him $15,000 per year—more than a third of his judicial salary. His income saved his life; the eight to nine patients who die a day in one of the hospitals featured in the film weren’t so lucky.
The HIV-positive founder of the Treatment Action Campaign, Zackie Achmat, is one of several inspirational figures in Fire in the Blood, challenging patent laws that prevented the importation of cheaper generic drugs. Gray’s movie reveals that capsules costing five cents in Thailand were selling for $13 in South Africa. Pfizer’s sales of the anti-HIV medication Fluconazole reached $1 billion per year—at up to $40 per tablet—when the average weekly wage in South Africa was only $68.
“At the moment we had our political freedom, HIV came along and robbed people of life,” Achmat says in the film. “In many ways, it’s worse than what happened under apartheid.”
Perhaps the biggest shock of all is Gray’s revelation that only 1.3 cents out of every dollar in sales goes into researching new drugs. The rest funds such things as entertaining doctors and paying shareholder dividends, huge salaries, and marketing costs.
Gray, who worked as first assistant director on Deepa Metha’s internationally acclaimed Water, points out that in India, access to medicine is still an important part of the patenting system. But this isn’t the case in South Africa. And he points out that the Clinton administration conveyed an ultimatum to then–South African president Thabo Mbeki that if he allowed generic AIDS drugs into the country, there would be ruinous consequences.
“The two things I get criticized most for…is not saying enough about the African government, especially Mbeki, and the other thing is being too easy on Clinton,” Gray says. “But I think it’s very true that Clinton has played an extremely important role post his presidency—first of all making it possible for drug prices to get lowered by rationalizing and consolidating orders, and in making sure there would be payment.”