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To start this reflection I recall what François Emile Zola stated in his “J’accuse”. With this undiplomatic way of getting into the topic, Emile Zola shows his outrage in a letter to the President of France at that time, Felix Faure. With a title which calls the attention, he says what the rest of the people do not dare say and he does not care about being accused of “criminal defamation”. He wants to say what he thinks and he does so in an accusatory and challenging tone.
HIV/AIDS RESEARCH AND TREATMENT ISSN 2377-8377 http://dx.doi.org/10.17140/HARTOJ-2-115 Open Journal Opinion "J'accuse": A Matter of Genocide Plea for *Corresponding author Access to Cure Hepatitis C Alcides Troncoso, MD, PhD Lecturer Department of Infectious Diseases * School of Medicine Alcides Troncoso* University of Buenos Aires Aires, Argentina E-mail: microbiologiayparasitologia@yahoo.com.ar Lecturer, Department of Infectious Diseases, School of Medicine, University of Buenos Aires, Aires, Argentina Volume 2 : Issue 4 Article Ref. #: 1000HARTOJ2115 To start this reflection I recall what François Emile Zola stated in his “J’accuse”. With this undiplomatic way of getting into the topic, Emile Zola shows his outrage in a letter to the Article History President of France at that time, Felix Faure. With a title which calls the attention, he says what th Received: November 15th, 2015 the rest of the people do not dare say and he does not care about being accused of “criminal th Accepted: November 19th, 2015 defamation”. He wants to say what he thinks and he does so in an accusatory and challenging th Published: November 20th, 2015 tone.
Citation In a different time and with different people, I am not a famous writer, not even a Troncoso A. "J'accuse": a mat- writer, but only a medical specialist in infectious diseases, who reported that there is a treatment ter of genocide plea for access to which heals people with Hepatitis C or Hepatitis C Virus (HCV) and Human Immunodeficien- cure hepatitis C. HIV/ AIDS Res cy Virus (HIV). New treatments recently approved or soon to be authorized will offer a range of Treat Open J. 2015; 2(4): 90-91.
advantages compared with their predecessors: multigenotypic activity, fewer side effects, and doi: 10.17140/HARTOJ-2-115 higher cure rates, including for those in advanced stages of infection. However, for those who do not know about it, these medications that cure hepatitis C are not for everyone. Although millions of people have been dreaming of the new treatments, with their better cure rates and lesser side effects, the therapy based on Pegylated interferon (PEG-IFN) and Resource-Based View (RBV) is still saving lives and is the only option avail- able in many countries. Although these new molecules will improve the quality of life of people with HCV and increase the number of people cured, their price will be out of reach of most of the people who need it.
We are witnessing a revolution in the treatment of HCV with powerful molecules ca- pable of curing the infection. There is no question that these treatments that can save millions of lives must be made universally available at an affordable price. What is the minimum cost per person to cure HCV? Whom do they benefit? Will they really benefit anyone? Access to medicines is dependent on their rational selection and use, the availability of financial resources, the strength of the health infrastructure and their affordability. As the high cost of medicines is a major factor limiting access to new drugs in developing countries. Pharmaceutical companies purposely maintain a confusion between the cost and price of medicines, suggesting there is an underlying cost rationale to justify the very high prices.
In developing countries, the power and influence of the pharmaceutical lobby, and the power of the pharmaceutical industry in the domestic economy, prevents any kind of transpar- ent process on price negotiations or any kind of public debate. In addition, a limitation of the Copyright accelerating access initiative has been the tendency to work mainly with ministries of health in ©2015 Troncoso A. This is an open developing countries.
access article distributed under the Creative Commons Attribution 4.0 International License (CC BY 4.0), It is worth recalling that the “infantile paralysis” or polio was one of the most danger- which permits unrestricted use, ous and contagious diseases in the first half of the twentieth century. Jonas Salk, an Ameri- distribution, and reproduction in can MD and Virologist Researcher, was a pioneer in the development of a preventive strategy any medium, provided the original against polio. For this reason, his work, which enabled effective immunization against the work is properly cited.
HIV/AIDS RESEARCH AND TREATMENT ISSN 2377-8377 http://dx.doi.org/10.17140/HARTOJ-2-115 Open Journal virus, was a fundamental base to eradicate this disease.
We all avoid facing painful truths about ourselves and others, in part because our knowledge of the truth entails the Despite being a milestone in medicine, Salk rejected responsibility for action. We can never exorcise our personal or registering a patent of the polio vaccine. Albert Sabin, another social evils unless we face them and call them by their names.
American virologist, whose work was also very important for We can never overcome our personal addictions unless we first childhood immunization by oral dose, also rejected to do it. Why recognize that we are an addict. We have to face the others and wasn’t there a patent? If Salk had registered the polio vaccine, admit that we are alcoholics as a first step in our recovery. That is he would have had millions of dollars in profits, about seven why the words have great power, and they can change the course billion. Both vaccines were used since the fifties, achieving the of our lives and even the fate of nations.
eradication of the disease in most of the world. Salk was asked about why he refused to register the patent of the polio vaccine: Exorcists say they cannot force an evil spirit to leave “There is no patent. Can we register de sun?”
the body of the possessed person until the name of that spirit is revealed. We will never put an end to the policy of blocking the Jonas Salk thought of a way to make science differ- use of antiviral drugs against hepatitis C until we call this policy ent, aimed at a universal benefit. It is important to emphasize by its name: genocide. For some of us, the right thing will be the principles of the scientific contribution of Sabin and Salk’s to use the word “genocide” whenever we refer to the policy of work, and to pay attention to the fact that they refused to be the denying medicines to patients infected with hepatitis C.
owners of the invention and they wanted to make it accessible to everyone, even though they could have had multimillionaire The word genocide has an archetypal power. It implies profits. I do not want to be part of a conspiracy of silence. I a more primitive sense of justice. The ancient gods ruled with am particularly interested in showing the truth of the entities in- greater moral certainty than our modern deities. Often modern volved in the plot against public health: nations, private corpora- justice is based on infinite degrees of guilt. But the gods of an- tions, health systems, etc. As a human being and as a physician, I tiquity genocide, whatever the medium, demanded quick justice know that it is not right to remain silent while sacrificing people and severe punishment. A murder has always been a murder.
with hepatitis C, and I definitely take the side of patients.
There was no difference between being killed by a deadly gas, a bayonet or if someone intentionally avoid providing available It is estimated that each year more than 350,000 people drugs to save lives.
die because of hepatitis C. Most of these lethal infections could be prevented with antiviral drugs of 3rd generation, which are It is ironic that many leaders of third world countries accepted, approved and clinically effective for this purpose. The have ratified the Rome Statute to support the International cost of these drugs is not an obstacle. If you share my moral Criminal Court (ICC). In doing so, these governments signed outrage as regards your colleagues on this senseless slaughter of a consent which states that individuals who have committed or those who will not have access to treatment, I urge you to do the instigated flagrant violations of international law, whether war right thing.
crimes, genocide and “crimes against humanity”, which include kidnapping and torture, will not be allowed to avoid processing.
For those who might have witnessed the consequences The element that defines the term “crimes against humanity” is that silence have had on the murder of tens of thousands of other the deliberate devaluation of human life. The devaluation of the citizens, who were perpetrated by governments which did not lives of people with hepatitis C by the authorities of most gov- assign any value to their fragile lives, doing the right thing may ernments would fit this definition.
th On 15th May, 2016, the metaphor of war against hepa- Learning what is right often involves the cumulative titis C may have been repeated again and again, sometimes by experience of realizing how many times we have done the wrong those who never fought or survived a war. But this is a war we thing (usually because it was the safe thing to do) or we have not have lost, not due to lack of effective weapons or brilliant strate- done anything. Sometimes we forget that we are responsible of gists, but because many of us were conscientious objectors. We the consequences of our actions as well as of our lack of action do not listen to our conscience, which tells us our obligations as when we have a responsibility to act. All the countries have the regards the patient in danger of hepatitis C. Thousands of pa- responsibility to protect the health of patients infected by the tients will continue to be murdered because of our silence, the deadly virus of hepatitis C, which is located in their body, facili- silence that has promoted these crimes against humanity.
The consequence of this lack of action and of indiffer- ence is that there are hundreds of thousands of patients who have their lives marked by unnecessary pain and suffering. The word that defines the consequences of this lack of medicine supply is “genocide”.