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Adherence to the bottom line, adherence to drug regimens

July 27, 2007

With AIDS medicines still so out of reach for so many who need them, it’s worrying—although predictable–to note the lack of responsibility taken by the pharmaceutical company Roche for the tens of thousands of people depending on their anti-retroviral drug, nelfinavir (Viracept). In June, Roche quietly recalled this common ART drug because of contamination, leaving many HIV positive people with the choice of giving up their life-saving medicines or taking potentially poisonous pills. (See the NYTimes report)

After being pressed for more information by activists, Roche finally admitted that contamination with a cancer-causing byproduct has been common since the drug was first produced in 1998, and that the contaminated drug has been distributed all over the world.

Roche needs to act more aggressively to make alternative and affordable treatments available. In a climate where some people still fear that lifesaving ART medicines are toxic, only fully responsive, ethical steps taken by manufacturers will undercut the damage a recall like this can do–not just to the treatment plans of specific patients taking the medicine involved, but also to the entire effort to use antiretroviral medicines fight HIV effectively.

It’s also interesting to consider this as a case of structural interference with drug adherence (more commonly thought of only as costs of treatment, distance to health facilities, etc.). More than any other factor, we tend to hold people with HIV themselves accountable for good adherence to their drug regimen. We charge them with the job of faithfully taking their medicines every day, and we often act as if the primary barriers to adherence are their attitudes or behavior, and the fault if they slip is theirs. Clearly this is not so in this case.

A pharmaceutical company should not simply be able to walk away, due to a flawed product, from people who rely on daily doses of one of its products to hold off a fatal disease. Those with the most power to act should be held the most accountable – especially when they are so handsomely paid and protected from competition. If we really want to support good drug adherence in people taking ART medicines –and thus make ART the most effective tool against the epidemic that it can be– we need to find ways to create and enforce structural supports to good adherence, as are many of the advocacy organizations. Providing pill boxes and calendars is not enough.