While MSF cannot work directly in Syria, it has collected testimonies from wounded patients treated outside the country and from doctors inside Syria.  The testimonies, collected from several people from various parts of the country, point to a crackdown on the provision of urgent medical care for people wounded in the ongoing violence in Syria.  

“In Syria today, wounded patients and doctors are pursued and risk torture and arrest at the hands of the security services,” said Marie-Pierre Allié, MSF president. “Medicine is being used as a weapon of persecution.”

Most of the wounded do not go to public hospitals for fear of being tortured or arrested. When a wounded person is admitted to a hospital, a false name is sometimes used to hide his or her identity.  Doctors sometimes provide a false diagnosis to help patients elude security forces, who search for patients with wounds consistent with those sustained in protests and demonstrations. People have suffered grievous injuries, including from shrapnel and from bullets that apparently explode on impact.  The testimonies recount instances of people shot by snipers.

“It is critical that the Syrian authorities reestablish the neutrality of healthcare facilities,” said Marie-Pierre Allié. “Hospitals must be protected areas, where wounded patients are treated without discrimination and are safe from abuse and torture, and where medical workers do not risk their lives by choosing to comply with their professional code of ethics.”

The injured are largely treated in clandestine treatment facilities by doctors trying to fulfill their commitment and duty to provide medical assistance. Improvised health clinics have been established in apartments, on farms, and elsewhere. Simple rooms outfitted as makeshift operating theatres, known as “mobile hospitals,” are used for surgical procedures.  Hygiene and sterilisation conditions are rudimentary and anaesthesia is in short supply.  Furthermore, the mere possession of drugs and basic medical materials, such as gauze, is considered a crime.

“The security services attack and destroy the mobile hospitals,” said a doctor who requested anonymity. “They enter houses looking for drugs and medical supplies.”

Security is the key concern for doctors working in the parallel underground networks. In the prevailing climate of terror, treatment must be provided rapidly since medical workers and patients must constantly change location to avoid detection. 

“We are constantly being pursued by the security forces,” said another physician. “Many doctors who treated wounded patients in their private hospitals have been arrested and tortured.”

It is extremely difficult for the clandestine health workers to treat major trauma cases and provide post-operative care. Additionally, they cannot obtain blood from the central blood bank, which is controlled by Syria’s Ministry of Defence — the only blood supplier in the country.

Only a few wounded patients have managed to find refuge in neighbouring countries, where they can receive proper—albeit delayed—medical care.   

“I was wounded in the thigh and the soldiers caught me,” recounted a patient treated by MSF. “They beat me on the head and on my wound, but I managed to get away with help from people in the neighbourhood. In the end, I found someone who could treat me — a nurse, not a doctor. He didn’t even have anaesthetic.”

Under the current circumstances, MSF’s assistance to Syrians requiring medical care is limited.  For months, MSF has been seeking official authorisation to aid the wounded in Syria, so far without success. The organisation is treating patients outside Syria and is supporting doctors’ networks inside the country, through the provision of medicine, medical supplies, and surgical and transfusion kits.   

Source: member // Medecins Sans Frontieres – UK 

[pharmamkting] That’s my takeaway from this comment by Marijn Dekkers, “outspoken” head of Bayer Pharmaceuticals, in which he not only disses patients but claims to have cured cancer!

“If you have cancer, you get a pharmaceutical product, and your cancer goes away. You’re quick to call the doctor and [say] the staff at the hospital was great. But the pill that did it gets forgotten. We struggle with getting society to put value on what we do, and it becomes particularly important as we get under more pressure to develop the next pill” (read the WSJ article here).

This guy must be living on another planet. That planet, of course, is Planet Pharma where the drug industry rules, all cancer has been cured by the industry and where patients bow when they see a pharma CEO ride by in his open-air limo!

I’ve brought up the subject of pharma taking most of the credit for improving cancer survival rates when in fact most of the credit in those gross numbers is due to the fact that many people have simply quit smoking. Dekkers’ remark, however, is the first time I’ve seen the drug industry take credit for curing cancers. Perhaps he was making unsubstantiated claims about regorafenib, a colon cancer drug Bayer is developing. It’s hardly a cure. “The median overall survival of patients on experimental regorafenib was 6.4 months. That compares to five months for patients who were given a placebo” (see “Bayer, Onyx cancer drug shows modest improvement in survival“).

On Quora, I posted the question: “How close are the pharmaceutical companies to “curing” cancer?” (see here) and got some interesting feedback. Dan Munro (@danmunro), Founder / CEO – iPatient, had this to say:

“While curing a given cancer is clearly a worthwhile goal – it is often not the primary focus – and early detection is still the leading indicator of successfully treating all cancers. Some cancers are simply pushed so far into remission that you’re more likely to die of a different cancer or old age in your sleep. It’s not a technical cure – but it’s a practical one.

“The sad reality is this: The death rate for cancer (adjusted for the size and age of the population) has dropped only 5% from 1950 to 2005 (see here).  

“One weapon that will aid in their research for effective treatments was announced at CES earlier this month. Life Technologies Ion Proton Genetic Sequencer.”

So, (1) the reality is that the death rate for cancer hasn’t improved very much in the past 50 years, and (2) pharma’s little “pills” haven’t contributed much to that statistic. Shame on Bayer for taking credit where none is due!

[Economist] TWENTY years ago North America, Europe and Japan produced almost all of the world’s science. They were the aristocrats of technical knowledge, presiding over a centuries-old regime. They spent the most, published the most and patented the most. And what they produced fed back into their industrial, military and medical complexes to push forward innovation, productivity, power, health and prosperity.

All good things, though, come to an end, and the reign of these scientific aristos is starting to look shaky. In 1990 they carried out more than 95% of the world’s research and development (R&D). By 2007 that figure was 76%.

Such, at least, is the conclusion of the latest report* from the United Nations Educational, Scientific and Cultural Organisation, UNESCO. The picture the report paints is of a waning West and a rising East and South, mirroring the economic shifts going on in the wider world. The sans culottes of science are on the march.

GERD is good

Comparisons of the scientific prowess of countries frequently begin with spending. One measure of this is GERD, gross domestic expenditure on R&D. Globally, GERD amounted to $1.15 trillion in 2007 (the last year the UNESCO report measures). That was up 45% compared with 2002. Moreover, in those five years Asia’s share of the total rose from 27% to 32%.

 

When comparing economies of different sizes, the share of national wealth spent on R&D is also useful—particularly as scientific excellence tends to concentrate itself in small areas of the world, allowing researchers in tiny countries like Singapore to challenge those of larger ones, such as America. In 2007 Japan spent 3.4% of its GDP on R&D, America 2.7%, the European Union (EU) collectively 1.8% and China 1.4% (see chart 1). Many countries seeking to improve their global scientific standing want to increase these figures. China plans to push on to 2.5% and Barack Obama would like to nudge America up to 3%.

The number of researchers has also grown everywhere. China is on the verge of overtaking both America and the EU in the quantity of its scientists. Each had roughly 1.5m researchers out of a global total of 7.2m in 2007. Nevertheless, the number of scientists per million people remains relatively low in China. And India, second only to China in the size of its population, has only a tenth as many researchers. This is a surprising anomaly for a country that has become the world’s leading exporter of information-technology services and ranks third after America and Japan in terms of the volume of pharmaceuticals it produces.

 

Having lots of boffins does not matter, though, if they are not productive. One indicator of prowess is how much a country’s researchers publish. As an individual country, America still leads the world by some distance. Yet America’s share of world publications, at 28% in 2007, is slipping. In 2002 it was 31%. The EU’s collective share also fell, from 40% to 37%, whereas China’s has more than doubled to 10% and Brazil’s grew by 60%, from 1.7% of the world’s output to 2.7% (see chart 2).

The size of Asia’s population leads UNESCO to conclude that it will become the “dominant scientific continent in the coming years”. But citation of English-language articles in Chinese journals by other publications remains low. This could be because Chinese science is poor or because researchers in America, Europe and Japan have an historical bias towards citing each other. The average American paper was cited 14.3 times between 1998 and 2008, whereas the average Chinese paper was cited only 4.6 times, about the same as papers published in India and less than those published in South Korea.

For science’s aristos, then, much of this suggests the tumbrels await. But the story does not end there. What also counts is the extent to which countries are successful in using the knowledge they generate.

One way of looking at that is to count how many patents a country produces. This can be tricky. A recent report from Thomson Reuters, an information firm that is also the source of much of UNESCO’s data on scientific publications, suggests that between 2003 and 2009 Chinese patent filings grew by 26%—far faster than anywhere else. By this measure China will become the world’s largest registrar of patents in 2011. There is a snag, though. Bureaucrats in Chinese patent offices are paid more if they approve more. As a result there is a mountain of Chinese patents of dubious quality.

UNESCO’s latest attempt to look at patents has therefore focused on the offices of America, Europe and Japan, as these are deemed of “high quality”. In these patent offices, America dominated, with 41.8% of the world’s patents in 2006, a share that had fallen only slightly over the previous our years. Japan had 27.9%, the EU 26.4%, South Korea 2.2% and China 0.5%.

The prospects for R&D investment by business look bright in many of the emerging scientific nations, however. Between 2002 and 2007 business investment as a proportion of GDP has risen rapidly in China, India, Singapore and South Korea (although India’s increase was from a low base). But at least one aristo is fighting back, for investment has risen rapidly in Japan.

Although much of this might seem cause for the old regime to fret, there is one other pattern worth noting: that of growing international collaboration. Thanks to cheap travel and the rise of the internet, scientists find it easier than ever to work together. According to Sir Chris Llewellyn-Smith, the chairman of the advisory group for another report on global science (to be published early next year by the Royal Society, the world’s oldest scientific academy), more than 35% of articles in leading journals are now the product of international collaboration. That is up from 25% 15 years ago—something the old regime and the new alike can celebrate.

That’s the premise of a new position paper, published today in the journal Nature by three leading obesity researchers from the University of California, San Francisco School of Medicine.

Yet people can, and often do, behave in very different ways.

A news search for the words “hero saves” will routinely turn up stories of bystanders braving oncoming trains, swift currents and raging fires to save strangers from harm. Acts of extreme kindness, responsibility and compassion are, like their opposites, nearly universal.

Why are some people prepared to risk their lives to help a stranger when others won’t even stop to dial an emergency number?

Scientists have been exploring questions like this for decades. In the 1960s and early ’70s, famous experiments by Stanley Milgram and Philip Zimbardo suggested that most of us would, under specific circumstances, voluntarily do great harm to innocent people. During the same period, John Darley and C. Daniel Batson showed that even some seminary students on their way to give a lecture about the parable of the Good Samaritan would, if told that they were running late, walk past a stranger lying moaning beside the path. More recent research has told us a lot about what happens in the brain when people make moral decisions. But are we getting any closer to understanding what drives our moral behavior?

Here’s what much of the discussion of all these experiments missed: Some people did the right thing. A recent experiment (about which we have some ethical reservations) at the University of Chicago seems to shed new light on why.

Researchers there took two rats who shared a cage and trapped one of them in a tube that could be opened only from the outside. The free rat usually tried to open the door, eventually succeeding. Even when the free rats could eat up all of a quantity of chocolate before freeing the trapped rat, they mostly preferred to free their cage-mate. The experimenters interpret their findings as demonstrating empathy in rats. But if that is the case, they have also demonstrated that individual rats vary, for only 23 of 30 rats freed their trapped companions.

The causes of the difference in their behavior must lie in the rats themselves. It seems plausible that humans, like rats, are spread along a continuum of readiness to help others. There has been considerable research on abnormal people, like psychopaths, but we need to know more about relatively stable differences (perhaps rooted in our genes) in the great majority of people as well.

Undoubtedly, situational factors can make a huge difference, and perhaps moral beliefs do as well, but if humans are just different in their predispositions to act morally, we also need to know more about these differences. Only then will we gain a proper understanding of our moral behavior, including why it varies so much from person to person and whether there is anything we can do about it.

If continuing brain research does in fact show biochemical differences between the brains of those who help others and the brains of those who do not, could this lead to a “morality pill” — a drug that makes us more likely to help? Given the many other studies linking biochemical conditions to mood and behavior, and the proliferation of drugs to modify them that have followed, the idea is not far-fetched. If so, would people choose to take it? Could criminals be given the option, as an alternative to prison, of a drug-releasing implant that would make them less likely to harm others? Might governments begin screening people to discover those most likely to commit crimes? Those who are at much greater risk of committing a crime might be offered the morality pill; if they refused, they might be required to wear a tracking device that would show where they had been at any given time, so that they would know that if they did commit a crime, they would be detected.

Fifty years ago, Anthony Burgess wrote “A Clockwork Orange,” a futuristic novel about a vicious gang leader who undergoes a procedure that makes him incapable of violence. Stanley Kubrick’s 1971 movie version sparked a discussion in which many argued that we could never be justified in depriving someone of his free will, no matter how gruesome the violence that would thereby be prevented. No doubt any proposal to develop a morality pill would encounter the same objection.

But if our brain’s chemistry does affect our moral behavior, the question of whether that balance is set in a natural way or by medical intervention will make no difference in how freely we act. If there are already biochemical differences between us that can be used to predict how ethically we will act, then either such differences are compatible with free will, or they are evidence that at least as far as some of our ethical actions are concerned, none of us have ever had free will anyway. In any case, whether or not we have free will, we may soon face new choices about the ways in which we are willing to influence behavior for the better.

Peter Singer, a professor of bioethics at Princeton University and a laureate professor at the University of Melbourne, is the author, most recently, of “The Life You Can Save.” Agata Sagan is a researcher.

So it is perhaps a sort of progress that the British Medical Journal and the international Committee on Publication Ethics were able to organize a meeting on the subject in London last week, gathering representatives from universities, funders, journals and lobby groups to discuss how the problem could be tackled in the United Kingdom (see Nature http://doi.org/hmx; 2012). The meeting broke little new ground, but its organizers do, at least, deserve credit for trying.

A big part of the problem is the lack of perceived risk associated with misconduct. Some fraudulent researchers might be sociopaths who don’t care about the rules, but many others simply believe that they can anticipate the outcome of a research project, and see no downside to fabricating the required results to save time, or tweaking results to achieve a stronger signal. Either way, stronger action and punishments are needed to discourage such misbehaviour. (Meanwhile, for colleagues considering blowing the whistle, the risks are glaringly huge — witness the plight of scientists, such as cardiologist Peter Wilmshurst, who have raised questions and have faced the full force of Britain’s ludicrous libel laws as a result.)

Could publications such as this one do more to deter cheats? Unfortunately, we are often in no position to flag up even proven cases of misconduct, and thereby highlight the risks that miscreants run with their careers. Yes, it is a journal’s primary job to clean up the literature, but when papers are retracted owing to misconduct, the libel laws (again) often prevent our editors from saying so. We know that this leaves the affected communities frustrated and in the dark. It leaves us frustrated, too.

So, with journals unable to push towards greater integrity and universities often unwilling to do so, should funding agencies be leading the charge? It is, after all, their money that is wasted if misconduct does occur.

Funding agencies in the United States do sometimes investigate misconduct. Research funded by the National Institutes of Health and some other government agencies falls under the remit of the Office for Research Integrity (ORI), which has the power to bar researchers from receiving future funding. However, as Nicholas Steneck, director of the research-ethics programme at the Michigan Institute for Clinical and Health Research in Ann Arbor, told the London meeting, this process probably misses most major misconduct. And the ORI can’t initiate investigations: institutions must conduct their own inquiries first.

In the United Kingdom, there seems to be little appetite for launching an overarching ORI-type regulator. Certainly, the existing independent advisory group, the UK Research Integrity Office in Falmer, is clear that it has no desire to take on such a role. British funding councils — in collaboration with the country’s universities — have chosen instead to produce a ‘concordat’ detailing good practice, to which institutions will be expected to sign up. This is laudable, but unlikely to strike fear into fraudsters and fabricators.

So, how can Britain highlight cases of misconduct and discourage it in future? Ultimately, the incentives probably need to come from on high, and the government could get the ball rolling by commissioning an anonymous survey on misconduct that UK researchers have witnessed and perpetrated. An official audit would offer a strong platform for others to build on — perhaps with a parliamentary inquiry and subsequent report on the damage done to UK science by misconduct, and an assessment of the options for tackling it and the investment needed. Funders and universities could then work together to establish common definitions of what counts as misconduct, and how it will be punished. And if a reform of the libel laws goes ahead, journals and other scientists would be able to do more to highlight and expose miscreants.

Sounds ambitious? If the solutions were easy, there wouldn’t be a problem to discuss. But there is, so we must face it.

Obama implores Congress not to “gut” investments in research, so American can maintain its spot as a world leader in medical innovation. That line will earn applause from the pharmaceutical and medical device industries, but it won’t be enough to deliver a health care economy that delivers a “fair shot” to everyone.

The president held out the continued possibility of saving health care costs with Medicare reform. “As I told the speaker this summer, I’m prepared to make more reforms that rein in the long term costs of Medicare and Medicaid, and strengthen Social Security, so long as those programs remain a guarantee of security for seniors,” Obama said. “But in return, we need to change our tax code so that people like me, and an awful lot of members of Congress, pay our fair share of taxes. Tax reform should follow the ‘Buffett Rule’:  If you make more than $1 million a year, you should not pay less than 30 percent in taxes.”

And he rebutted Republican accusations that his signature 2010 health reform law amounts to socialized medicine. “I’m a Democrat. But I believe what Republican Abraham Lincoln believed: That government should do for people only what they cannot do better by themselves, and no more,” he said. “That’s why our health care law relies on a reformed private market, not a government program.”

Obama makes it clear that he sees the giant health care sector as a place ripe for jobs growth. The American Association of Medical Colleges projects a shortage of 90,000 doctors over the next 10 years. It’s more than double that for the nursing industry, where the American Nursing Association sees a potential shortage of 260,000 nurses by 2025. These shortfalls will only be worsened as an additional 30 million people get health insurance under the 2010 health reform law.

But a national workforce commission established under the health care law has been chronically underfunded by Congress. The training programs that will be needed to fix these shortages have a slim to little chance of getting any funds. Appropriators have no room to give precious federal dollars to new programs while they are slashing old sacred cows in the austere spending environment that has reigned on Capitol Hill since Republicans took the House in 2011.

And while investments in research are nice, what medical device companies want even more is for Congress to take back a $20 billion tax it imposed on the industry to help cover the cost of the health reform law. Stephen Ubl, president of Advamed, a medical device lobbying association, says the tax is already causing layoffs.

Obama doesn’t get a break from hospitals either. The American Hospital Association says a coming 2 percent cut to Medicare and other cuts will cost them 278,000 jobs as revenue drops from Medicare and Medicaid. In the health care world, federal funds are the spigot for job creation, and no State of the Union speech is going to change the spending environment on Capitol Hill.

Seven years ago, he suffered a paralyzing stroke. Today he can only move his head, cannot speak and needs constant care.

And he wants to die.

To try to ensure that whoever ends his life won’t be jailed, the 57-year-old Nicklinson recently asked Britain’s High Court to declare that any doctor who gives him a lethal injection with his consent won’t be charged with murder. This week, the court will hold its first hearing on the case.

“Most people who want to die, who are physically able to do so, can lawfully commit suicide,” said Nicklinson’s lawyer, Saimo Chahal.

But that’s not the case for Nicklinson, who has “locked-in syndrome” — a condition in which a person’s body is paralyzed but mind intact.

Under U.K. law, anyone who helps Nicklinson die could be charged with murder, even if they are carrying out his wishes. A murder charge has a mandatory life sentence, regardless of the motive or circumstances.

No one suspected of aiding a loved one’s suicide has been charged with such a crime in Britain in recent years. But Nicklinson doesn’t want to take any chances. Instead he wants to change the legal definition of murder to exclude euthanasia, arguably a long shot.

Emily Jackson, a medical law expert at London’s School of Economics, said Nicklinson may have a plausible case. “He is making a very interesting argument,” she said.

Euthanasia is legal in the Netherlands but requires a long-term relationship between doctors and patients, a rule that excludes most foreigners. Assisted suicide is legal in Switzerland, including for foreigners, but Nicklinson does not want to go there to die.

Nicklinson argues that British law hinders his right to “private and family life” — guaranteed by the European Convention on Human Rights — on the grounds that being able to choose how to die is a matter of personal autonomy.

“He argues that it’s unfair on him and that a humane legal system would enable somebody in his circumstances, with considerable safeguards, to get help from a doctor to exercise a right, which he has in theory, but is deprived of in practice,” Chahal said.

The Ministry of Justice has applied to dismiss Nicklinson’s suit since it could involve changing the law — which must be done by Parliament, not the High Court.

Nicklinson communicates mostly by using a computer that detects his blinking. In a statement, he described his life as “dull, miserable, demeaning, undignified and intolerable.”

He has refused since 2007 to take any life-prolonging drugs recommended by doctors, including heart drugs or blood thinners. He only takes medicines to make himself more comfortable, such as those to reduce muscle spasms. His wife, Jane, a trained nurse, said he could be at risk of another stroke or a heart attack.

Jane described her husband as “a real alpha male” who was very active before his stroke. “He was tall, dark and handsome,” she says of the night they met on a blind date in Dubai. The two later also lived in Hong Kong, Malaysia and Britain with their two daughters. Nicklinson chaired a sports club that ran rugby events in the United Arab Emirates, mixing with elite players and officials.

“It was a dream come true for him,” his wife said.

Jane said she and their two grown daughters didn’t initially agree with her husband’s choice to die. “It was very upsetting and obviously it’s not what we want, but it’s what he wants and it’s his life,” she said.

Nicklinson spends most of his days at a computer he controls by blinking, writing emails and surfing the web. Jane said he rarely leaves his room in their bungalow in rural Wiltshire, southwest England, except to watch television in the evenings. He’s also writing his memoirs.

It’s amazing what he remembers,” his wife said. “His mind is completely unaffected.”

Like the renowned physicist Stephen Hawking, who recently turned 70, Nicklinson has not lost any of his intellectual capacities. Hawking has Lou Gehrig’s disease, a degenerative condition that kills most people within a few years. He has repeatedly said he doesn’t think about his physical limitations, which haven’t prevented him from revolutionizing the understanding of black holes and the origins of the universe.

A recent British commission headed by a former justice secretary concluded there was a strong case for allowing assisted suicide under strict criteria. The commission was set up and funded by campaigners who want the current law changed. The report did not support euthanasia and recommended assisted suicide only be allowed for terminally ill people, which would exclude Nicklinson.

In 2009, the British government’s top prosecutor said people who helped terminally ill relatives and friends die were unlikely to be charged if they acted out of compassion. From 2009 to 2011, 40 cases of people suspected of helping loved ones die were reported to the government prosecutor; none was charged.

In 2002, the Netherlands became the first country to legalize euthanasia, allowing doctors to end the lives of patients whose suffering is “unbearable and hopeless” — not just those with terminal illnesses. In recent years, the country’s rates of euthanasia and physician-assisted suicide have risen slightly, but still account for less than 3 percent of all deaths.

Switzerland allows doctors to prescribe a fatal dose of medicine for patients to take themselves. Since 2001, more than 160 Britons have traveled to the Dignitas clinic, near Zurich, to die.

Nicklinson considered going to Switzerland, but his wife said he decided against it for several reasons, including the approximately 6,500 pound ($10,000) cost. Nicklinson is currently receiving legal aid from the government to cover most of his lawyer’s fees.

Euthanasia is also legal in Belgium, Luxembourg and the state of Oregon in the United States.

Critics of euthanasia say the U.K. should focus more on improving care for the chronically and terminally ill instead of legislating mercy killing.

“I’m massively sympathetic to (Nicklinson’s) situation, but I don’t think we should change the law when it will impact hundreds of thousands of other people,” said Dr. John Wiles, chairman of Care Not Killing, an alliance that opposes euthanasia. He warned that legalizing euthanasia might worsen treatment of elderly people and the terminally ill.

Wiles doubted enough safeguards could ever be in place. “However narrow you try to make it, in principle, we would be allowing the killing of other members of society for the first time,” he said. “If we change the law, we’ll be saying to people, ‘If you don’t like the care you’re getting, you can just end it.’”

The British Medical Association also opposes any changes that would permit assisted suicide or euthanasia. While patients have the right to their medical records, the group advises doctors to refuse to share such reports if they suspect the information will be used to commit assisted suicide abroad.

Nicklinson’s wife, Jane, said her husband simply wants the right to choose when to end his life. She said he began asking to die as soon as he could start communicating after his stroke, once he realized he wouldn’t improve.

“I’ve tried many times to change his mind, but he is adamant to see this through,” she said.

“Scientists at the University of Wisconsin in the United States and at Erasmus University Medical Center in the Netherlands say they are voluntarily halting their work for 60 days,” stating “the two months will give governments, international organizations and the scientific community time to determine whether the research can be conducted safely,” VOA News writes (1/21). The WHO is expected to organize a forum in the coming weeks to discuss the issue, Agence France-Presse reports (Sheridan, 1/21). “Suspensions of biomedical research are almost unheard of; the only other one in the United States was a moratorium from 1974 to 1976 on some types of recombinant DNA research, because of safety concerns,” the New York Times notes (Grady, 1/20).

Trading life-saving meds for cash highlights the relationship between employment and eligibility requirements for programs such as the AIDS Drug Assistance Program (ADAP) or HIV/AIDS Services Administration (HASA), as some HIV-positive individuals have to choose between holding a job and keeping benefits from these types of assistance programs. It also raises the question of how advocates can help people living with HIV better understand their options when receiving health care, so that they won’t feel pressured to partake in illegal activity.

The Uptowner reported:

Street sales have been particularly noticeable near uptown subway stations for more than six years, according to Dr. Michael Mowatt-Wynn, the president of Precinct 33’s Community Council. Prescription painkillers are prevalent, but the most popular drugs aren’t addictive and don’t produce any kind of high: HIV antiretroviral medications. …

[...] “I saw a mother with children in tow, no more than 5 or 6 years old,” Mowatt-Wynn says. “She was selling her HIV medicine, saying she needed to get food for her children. So she was basically selling herself. It’s a form of medical prostitution — that’s what we call it.”

In other countries, HIV medication is expensive and uncommon, making it a lucrative product for the black market. Buyers stand around the more popular uptown subway stations as if it’s a full-time job. From 9 to 5 Monday through Friday, they’re buying prescription medication from people who will use the proceeds to buy food, pay bills or fuel an addiction. Pharmacists then buy and repackage the drugs so they’ll sell for higher prices and ship them to countries with high demand, like the Dominican Republic and Mexico, [Pablo] Colon [the senior HIV counseling and treatment specialist at the New York City HIV organization Iris House] says.

According to The Uptowner, as a way to deter these sales, the “council and [33rd] precinct have instituted new policies to try to reduce the drug trade, placing cameras on lampposts at the most popular subway stations and stationing patrol officers nearby.”

City Limits also reported on the same issue:

… [A] bill sponsored by New York Sen. Kemp Hannon and passed by the Senate in June could close that gap if approved by the assembly this year.

The bill identified an “exploding black market in non-controlled substance medications,” including AIDS medications that are either sold to pharmacies or shipped overseas. Under the bill, first degree “criminal diversion of prescription medications and prescriptions” moves from a C felony (with likely maximum jail time of five to 15 years) to a B felony, for which the maximum is eight to 25 years.

Pharmacists play a crucial role in the trafficking as well. Ms. Cruz, who has sold her medications in the past, provided City Limits with the following scenario:

The HIV [positive] patient calls to let the pharmacist know in advance that it’s not really the pills he or she is interested in buying, but something else. Upon arrival at the pharmacy, the pharmacist scans the barcode on the bottle of pills, and then hands over a plastic bag filled with a few hundred dollars, instead of the medication.

The pharmacist can then sell the pills back to drug dealers or ship them directly overseas.

Have you ever considered selling your AIDS meds to make ends meet?

[Editor's note: Sadly, Pablo Colon passed away on Dec. 30, 2011, at the age of 49.]

Warren Tong is the associate editor for TheBody.com and TheBodyPRO.com.