a1279: Wall Street Journal article (fwd)

[Bob Corbett <corbetre@webster.edu>]

From: CLaBas1@aol.com

(Forwarded by Christine LaBastille)



March 14, 2002

Sending AIDS Drugs to Haitians
In Need Is MIT Student's Project

By RACHEL ZIMMERMAN
Staff Reporter of THE WALL STREET JOURNAL


CAMBRIDGE, Mass. -- Propped up on his dormitory bed, Sanjay Basu sets out on an unusual task: telephoning every pharmacist in New Hampshire.

"Hi, I'm calling from MIT down in Boston," says the 21-year-old neuroscience major, repeating a pitch he's made hundreds of times. "I'm part of a nonprofit pharmacy network that distributes AIDS medicines. Can I speak with a supervisor?"

For the past year, Mr. Basu's tiny dorm room, sporting a Che Guevara flag and a shelf of Noam Chomsky books, has been transformed into a prescription-drug-transfer center, where he collects and then sends thousands of doses of AIDS medicine to a clinic in Haiti . Between classes, the senior is building a network of pharmacists who send him FedEx packages of unused AIDS drugs, sometimes secretly. So far, he has recruited 26 in 18 states.


They send him drugs that were returned because the patients have become drug-resistant, or because side effects caused them to switch medications. Sometimes, family members return pills after a patient has died.

Many state laws forbid redispensing drugs once a patient has taken them home. Returned pills are supposed to be destroyed, primarily for safety and liability reasons. Drug makers pay companies called "reverse distributors" to collect and incinerate returned and expired drugs. Doctors and pharmacy administrators say that millions of doses are thrown away every year.

But a few pharmacists ignore the laws and hand over returned AIDS medicines to groups ministering to the sick and dying. "It's such a terrible waste," says Michael Sillman, a pharmacist at St. Francis Memorial Hospital in San Francisco who collects unused medicines for Mr. Basu's project.

"The medicines pile up and they get near their expiration date and I just can't bear to destroy them," says another pharmacist who asked not to be named because she believes she is violating the law by donating AIDS medicines to Mr. Basu.

While world attention is focused on massive AIDS programs announced by international health organizations or drug companies, several of these well-financed and professionally organized efforts haven't delivered a single dose to patients yet. Mr. Basu's little enterprise is gathering its supplies pill by pill -- 10,000 pills so far.

"It's an activity that -- if you look at it from a legal perspective -- shouldn't occur, but from a greater-good perspective, if it's done responsibly, it's pretty hard to prosecute," says Carmen Catizone, executive director of the National Association of Boards of Pharmacies, a not-for-profit group in Park Ridge, Ill.

The U.S. Food and Drug Administration wouldn't comment on Mr. Basu's specific situation. The FDA says the federal Prescription Drug Marketing Act, with some exceptions, calls for distributors of medicines to be licensed by the state, which Mr. Basu is not.

Locally, laws vary from state to state and are often a patchwork of agency regulations. In Massachusetts, Mr. Basu's work falls into a murky area.

James Coffey, associate director of the Massachusetts Board of Registration and Pharmacy, which regulates retail pharmacies, says that in his state, AIDS medicines are considered a controlled substance. "I am unaware of any statute or regulation in Massachusetts that would entitle a student to dispense a controlled substance" without a special exemption from the health department, he says.

Grant Carrow, director of the Massachusetts public health department's drug-control program, says certain overseas donations are legal with specific state approval of a written application. But all drugs donated must be unopened, sealed, unexpired and in the original manufacturer's packaging.

Mr. Sillman, the San Francisco pharmacist, tries to avoid one of the more obvious legal problems. He uses the shipping labels Mr. Basu sends him, but instead of sending the medicines to the student's dorm, he sends drugs to Partners in Health, a Boston nonprofit organization that works with Mr. Basu and is affiliated with the Haitian AIDS clinic. "It would be a bit of a sticky wicket for a pharmacist to send drugs to a student," he says.

Mr. Basu spent last summer handing out antiretroviral medicines in an SUV-turned-mobile-treatment-unit on the Burma-Thailand border. In the fall he will study medical anthropology and the economic and social history of medicine at Oxford University as a Rhodes Scholar.

He minimizes the legal issues surrounding his work. "I think, to be most honest, we haven't been too worried about legality. We're so small (and, collectively, quite radical politically), that legality is less of a concern for us than patients' lives, and pushing the line on legality might just be the type of thing we'd want to do," he says via e-mail.

Robert Sales, an MIT spokesman, says Mr. Basu could always get a license if necessary. "We encourage our students to be public-spirited and we are proud of what Sanjay is doing," he says.

With about $1,000 from MIT, which subsidizes his activities as it does other campus organizations, Mr. Basu has put in about $1,000 of his own money to send the pills he collects to Partners in Health. He said he started out trying to solicit donations from big drug companies, but after "about 35 or 40 phone calls," he received nothing.

Raised in conservative Naperville, Ill., by parents from Calcutta -- an engineer and a teacher -- Mr. Basu was "aloof from politics." In his first year of college, he was moved by a lecture on the Rwandan genocide by Mr. Chomsky, the leftist linguistics professor at MIT.

During an internship at Partners in Health, which is affiliated with Harvard Medical School, he became an activist. He chose to follow the pragmatic approach of Partners' pioneering AIDS doctor, Paul Farmer. "Paul really had a very concrete way of solving things: Instead of trying to do everything politically … he just went straight to Haiti and proved everyone wrong," Mr. Basu says.

Dr. Farmer now treats about 100 patients in the Haitian clinic where Mr. Basu's drugs end up. "In a more rational world, there would be no need for this sort of effort," says Dr. Farmer, in an e-mail from Haiti . "Unfortunately, we're two decades into this terrible epidemic ... and we still have to fight for access to these meds. So efforts like Sanjay's are critical."

There are other niche groups in the underground world of AIDS-drug recycling. Aid for AIDS, in Manhattan, collects unused medicines and ships them to clinics in Latin America. Executive Director Jesus Aguais says he has provided antiretroviral medicines for about 400 patients but figures he has tapped into just a fraction of the unused AIDS drugs available.

Matt Anderson, a doctor and assistant professor of family medicine at the Albert Einstein College of Medicine in the Bronx, has been sending a small supply of AIDS medicines to Guatemala. He gets the drugs mainly from patients. "Combivir is $10 a pill," Dr. Anderson says. "People are aware of how valuable these medicines are." Dr. Anderson sends unused, but sometimes opened, containers of medicine to a clinic through volunteer couriers at the Airline Ambassadors, a nonprofit outfit started by an American Airlines flight attendant, with the airline's blessing.

Others illicitly swap AIDS medicines over the Internet. And for years doctors and HIV-positive patients in the U.S. have used unregulated channels to trade expensive medicines or get them to people who are uninsured and unable to pay for the life-prolonging drugs.

Many AIDS-drug recycling programs have come and gone. Partners in Health has moved away from such donations. But it still encourages Mr. Basu. "We have made this exception for Sanjay Basu's work because he was trained by PIH, knows our needs and is educated about issues surrounding HIV, poverty, and access to care, including the history of abuse of drug donations by those unqualified to use them," says Kathryn Kempton, director of procurement for Partners in Health.

Mr. Basu is recruiting new students into the pharmacy project from the University of Pennsylvania, the University of Maryland and other campuses. He and his small group of undergraduate partners will soon start shipping drugs to a clinic in Tanzania.

Write to Rachel Zimmerman at rachel.zimmerman@wsj.com