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 While regulators warn that buying drugs online is risky, scientific
data presented at a recent medical conference suggest that treatment
arranged through buyers club can be just as effective as through
conventional channels.
Will Nutland, who supports a drug-buying network in London and takes
Indian-made generic drugs that are not available through the health
service to prevent HIV infection, thinks the latest research will
build confidence in such schemes.
"This new data shows that so far we've got it right," the HIV
activist said. "It gives us a boost in confidence in the types of
drugs that are available online."
The buyers clubs' websites act as middlemen by providing details of
trusted online pharmacies and drug manufacturers, exploiting a
loophole in World Trade Organization patent rules that allows
small-scale imports of medicines for personal use.
Like Ron Woodroof, the 1980s AIDS patient in the movie 'Dallas
Buyers Club', the sponsors of today's drug clubs aim to help
patients who can't get the drugs they want through local healthcare
systems by bringing in medicines from abroad.
But while Woodroof had to smuggle drugs in bulk across the Mexican
border, users of modern-day clubs can, in many countries, tap orders
into their computers quite legally.
Savings can be huge. A month's generic supply of the pre-exposure
prophylaxis (PrEP) HIV drugs emtricitabine and tenofovir costs about
45 pounds ($56) online in Britain, around a tenth of Gilead
Sciences' branded version Truvada.
A Indian-made course of treatment for the liver-destroying disease
hepatitis C, meanwhile, can be had for around 1,000 pounds against a
list price for branded drugs of around 35,000.
Gilead is also a leading producer of patented hepatitis C drugs,
along with Merck and AbbVie.
BRAVE ENOUGH TO TRY
"Resorting to a buyers club is clearly not conventional medicine but
it is something some people have been brave enough to try and it
seems to be working," said Andrew Hill of London's Chelsea and
Westminster Hospital.
Data presented at the Oct. 23-26 HIV Glasgow conference showed
generic drugs bought via buyers clubs in Australia, Britain, Russia
and South-East Asia by a total of 900 patients delivered hepatitis C
cure rates of around 95 percent. That is similar to outcomes in
clinical trials using the original brands.
Another piece of research involving more than 200 gay men in London
taking generic PrEP bought through a buyers club found that their
drugs, mostly made by India's Cipla, were both safe and effective at
preventing HIV infection.
Such observational studies do not have the rigor of full-scale
clinical trials but they do provide reassurance.
"What this sort of data does is give doctors and patients some faith
that this isn't an act of complete lunacy that is going to cause
patient harm," said James Freeman, a Tasmanian doctor behind a
hepatitis C drug-buying club.
For Freeman and other critics of the pharmaceuticals industry, the
advent of today's buyers clubs is just the latest chapter in an
ongoing war over drug prices, with parallels to the battle over
getting cheap HIV drugs into Africa.
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In the 1990s, HIV drugs costing more than $10,000 per patient a year
were simply out of reach for millions of people in the developing
world. Today, thanks to cheap generics, the cost for the poor has
been slashed to around $100.
The need for those laboratory tests is controversial, since it costs
money to test people taking medicines that were not prescribed by
the official healthcare system in the first place.
But Nneka Nwokolo, who presented the data on PrEP in Glasgow,
believes it makes sense, given the proven efficacy of PrEP in
several clinical trials. She works at a National Health Service (NHS)
sexual health clinic in London's Soho that has been offering blood
tests for generic PrEP users since February.
"HIV rates among gay men are not going down, despite all our
interventions, including promoting condom use. But we know PrEP
works and it has been shown to make a significant difference to HIV
acquisition," she said.
Clinical trials have shown PrEP cuts the risk of catching the virus
during sex by more than 90 percent.
PATCHY ACCESS
Across Europe and around the world access to PrEP remains patchy. In
Britain, routine use is stalled by a funding row, as well as doubts
over cost-effectiveness, based on the high price of branded Truvada.
Access to hepatitis C drugs faces similar budget constraints in many
countries, given the high cost of brand-name products. Gilead's
Sovaldi initially cost $1,000 a pill in the United States, although
competition has since pushed prices down.
Gilead said in a statement that it worked "to ensure broad access to
its medicines through dialogue and efforts with payers and other
stakeholders, including governments."
But HIV activist Nutland, who is also a research fellow at the
London School of Hygiene and Tropical Medicine, believes drugmakers
must do more to make their products affordable.
"It's an absolute scandal that the prices are so high that even
wealthy national services are saying they cannot afford the costs of
these drugs."
(Editing by Anna Willard)
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