The Reader's View
Doctors without regrets

By Eric Goemaere
Special to The Times

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Collin Levey's assertion that generic AIDS medicines are unsafe and ineffective ("Cheap drugs help no one if they're not effective," Times guest column, Nov. 12) is deliberately misleading. Just like physicians in the U.S., I treat patients with generic medicines every day and would never consider using "inferior" or "untested" drugs, as Levey implies.

Using low-priced generic medicines, approved by national drug regulatory authorities where we work, as well as by the World Health Organization (WHO), has allowed Doctors Without Borders to treat more than 23,000 people with HIV/AIDS in 27 countries, including 2,000 here in South Africa.

Our clinical results, which parallel those found in the U.S., have been published in peer-reviewed medical journals and presented at international conferences.

Most importantly, for my patients and thousands of others, the availability of treatment means that AIDS is no longer an automatic death sentence.

It is important to understand that AIDS treatment in South Africa and elsewhere has only been possible because of dramatic drops in the price of antiretrovirals, resulting from generic competition. Four years ago, the price of triple therapy in South Africa was $15,000 per person per year. Today, it is $185. This has created a seismic shift in the willingness and ability of the government to scale up treatment.

The fact that several generic AIDS medicines were recently removed from the WHO prequalification list is not evidence that the prequalification process is weak. As the recent recall of Merck's Vioxx shows, regulating brand-name, as well as generic, drugs requires constant vigilance. Unlike Vioxx, the generic AIDS medicines were withdrawn from the WHO list to resolve important questions about the paperwork demonstrating the drugs' bioequivalence — not because of deadly side effects.

There is no doubt that the generic-drug manufacturers whose AIDS medicines were delisted must adhere to strict international standards and submit new data to WHO and drug authorities urgently. But the United States Food and Drug Administration is not the global arbiter of drug quality. If we had waited for the U.S.' stamp of approval, as the Bush administration is requiring in the President's Emergency Plan for AIDS Relief, thousands of lives would have been needlessly lost.

People with HIV/AIDS in South Africa and throughout the continent continue to fight hard for access to affordable medicines. This is no "Western spitball contest over drugs, pricing and intellectual property rights." For our patients, and for millions of people with HIV/AIDS in developing countries, it is a matter of life and death.

Dr. Eric Goemaere is head of mission for Doctors Without Borders (Médecins Sans Frontières) in Khayelitsha, South Africa.