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Oct 1, 2005 (Vol. 25, No. 17)

GEN Talks with President Bill Clinton

  • Former President Bill Clinton remains committed to the battle against HIV/AIDS. He has made it a focal point of the work of his Clinton Foundation.

    President Clinton has said that until we combat the pandemic in the developing world, where more than 90% of the 40 million people worldwide who have HIV/AIDS live, it will be impossible for these countries to achieve their social and economic development goals.

    Acting on this commitment, the Clinton Foundation HIV/AIDS Initiative was set up to help such countries plan and implement large-scale integrated care, treatment, and prevention programs.

    In August, GEN's Publisher, Mary Ann Liebert, sat down with President Bill Clinton in his Harlem offices in New York City. The exclusive interview, which was published in the September issue of the peer-reviewed journal AIDS Patient Care and STDs, is available online at

    www.liebertpub.com/APC.

    Following are excerpts from that conversation as well as President Clinton's thoughts about other issues of pertinence to the biotechnology community.

  • MAL: You have played a major role in helping to negotiate inexpensively priced generic AIDS drugs for the developing world. But what do we do about patient compliance? It's a big issue in the U.S. Isn't it even more of a problem in the developing world where people do not have the same access to health care and health care professionals?

    BILL CLINTON: Essentially, there are over 40 million people who are HIV positive, and somewhere between 6.2 and 6.3 million who need medicine in the developing world. Everybody gets AIDS medicines in America, Europe, Japan, and Brazil. But if you look at the rest of the world, there were approximately 270,000 [receiving therapy] in 2003. Today, the most optimistic numbers are that 700,000 people are getting medicine, of which our foundation provides for 110,000. We'll be at 300,000 by the end of the year.

    On the other hand, if you don't have compliance, you might as well not have the medicine. We train people before we distribute [the drugs]. For example, we're involved with the Indian Ministry of Health in India in training 700,000 doctors over the next year.

    The second thing we've done is to negotiate steep reductions in the cost of testing. Otherwise, you don't know if the medicine is working and if you need to change it.

    In America we pay for the complement of tests somewhere between $200 and $400 a year. We've got it down to $20 a year in the developing world.

    Interestingly enough, these are not generic companies [involved here]. These are big companies that have volunteered to lower these costs. They think they can recover their base costs with high volume because we're going to get the testing out there to a lot of people.

    We just negotiated with the Chinese, who provide the component products to the drugs used by the Indians and South Africans, a 20% reduction in the components. In addition, we made a commitment to do what we did with the Indian and South African companies.

    We're sending in retired manufacturing executives and others trying to make sure that we get the Chinese capacity to produce generics to the point where they'll be approved by the World Health Organization. We may be able to lower the price as much as to a hundred dollars a person a year.

    MAL: What about AIDS in Russia?

    BILL CLINTON: We just started in St. Petersburg and we're about to start in the Ukraine. Their [HIV] rates are actually growing faster in Russia and the former Soviet Union than in any place else.

    In Russia and throughout the former Soviet Union, we're almost starting from scratch. There is a little bit of treatment there. There is some local leadership on the prevention front. But we've got a long way to go. President Putin's government is beginning to take it seriously.

    I know that President Yush-chenko in the Ukraine takes it very seriously because I had a long conversation with him about it. He believes the numbers that they have reported of [HIV] infections in the Ukraine are too low. He believes it's a bigger problem.

    MAL: Are you surprised by the recent changes in National Institutes of Health policy that will restrict and, in some cases, prohibit, NIH scientists from receiving consulting fees from industry? There are also proposed restrictions on family investments in biotechnology and/or pharmaceutical stocks. NIH is having problems attracting and retaining talented researchers, and this new mandate is sure to exacerbate that problem.

    BILL CLINTON: Yes, I am surprised. I think it was because they were getting a lot of criticism about the way the pharmaceutical industry worked with not just the NIH, but with universities, and the way drugs were priced. It also surprises me since this administration is so close to the pharmaceutical companies.

    I think the more money you put into research the better. There has got to be a way to stop the conflicts.

    Most of the new drugs that have been patented in the last six years did come out of government funded research, either at universities or at the NIH. And there was this strong feeling based on a book done by Marcia Angell [The Truth About Drug Companies] that a lot of abuses had occurred in pricing and in the FDA patenting processes. It looks to me like you could fix that. I mean the problem there is not that we're doing joint research.

    Angell pointed out that these drugs were basically being priced out of the range of people when all the research had been done by government funded researchers. And then the rules permitted the drug companies to buy the patent from [academic researchers], like if Duke University had an NIH grant and they developed Drug X.

    The drug company could come and say they had to earn an exorbitant amount on this drug that they spent no money developing. They spend more than twice as much on administration and marketing than on research.

  • MAL: The biotechnology industry is very concerned about the NIH restrictions; many are small companies, research is very costly, and drug development takes years. The opinions of NIH researchers are very valuable, and such consultancies are important if the promise of bench to bedside is to be fully realized.

    We're relying more so on these companies to develop vaccines and new drugs. The pharmaceutical industry, by the way, has always put enormous sums of money millions and millions of dollars into supporting biomedical research. The NIH is not solely responsible for the funding that has led to new drugs and therapies.

    The goal of NIH has always been to fund research that may lead to drug development for patient benefit. It takes companies years to bring a product to market. Additionally, many companies are no longer developing vaccines, and new vaccines are an urgent imperative.

    BILL CLINTON: That's exactly right. The small biotech companies are really important and they probably should be treated differently.

    One of the very few areas where I always was in agreement with Newt Gingrich was on increased spending on research. We more than doubled biomedical research funds.

    I tried to get a bill passed through Congress to take some of that burden off of [drug companies] by giving [them] a big tax credit for work in the development of any kind of vaccine or medication in areas where the only companies that could do the research are in rich countries and most of the people that have the problem are in poor countries. They can't be expected to shoulder that burden on their own or just in return for a modest amount of government support on the research.

    The whole structure of the way we fund research in areas like vaccines is a problem. You have to almost immunize people from liability to get people to develop vaccines.

    But apart from vaccines, there is a second set of problems. Forget about AIDS, look at TB and malaria. If you wanted a new generation of medications to deal with [these diseases], there would be almost no incentive for any of the companies with the intellectual brainpower to deal with it because all the people that have the problem are in countries too poor to pay for any new drug. So that whole thing needs to be completely restructured. You've got to change the financial incentives if you want them to do that.

    MAL: We're also losing talent to overseas research centers because of the federal ban on new embryonic stem cell research.

    BILL CLINTON: I think that was a big mistake. We're going to lose a lot there unless we have more independent efforts like the one in California.

    If you don't have venture capital going into this research, which is hard to do since the lead times for returns are long, then you almost have to have three or four states follow in California's lead.

    If New York, Illinois, Texas, Florida, or some of these other places would make a comparable commitment to the one made by California, and do it just for stem cell research, it might aggregate up to as much as the federal government might have done. Otherwise, we're going to have a significant erosion of scientific talent in this country.

    MAL: We also have a problem in that if you took away all the foreign talent in this country in the labs and research centers like MIT, there would not be enough researchers to begin to tackle these medical problems. A lot of these foreign scientists are going to go back home because of the constraints that are in the U.S.

    BILL CLINTON: I agree with that. I also think there are two issues involved here. One is that the anti-terror initiatives of the [U.S.] should be reviewed in terms of their entire impact on foreign students coming and staying here.

    The other is that if you look at the shortage of the scientific and technological workforce in America compared to other countries with whom we're competing, it would entirely evaporate if the participation of women, African-Americans, and Latinos in scientific and technological fields were equal to that of white males.

    If you got it up to the white male level, the shortfall would totally go away and we would be competitive with other countries.

    So there needs to be a serious effort made in this country to try to get really bright young minorities and women into science and technological fields. It's immensely rewarding work.

    And it's critical to America's long-term viability, not only economic viability, but just as a society as a healthy place.



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