One of the more common sentiments I hear from people living with HIV is that the pharmaceutical industry will never cure HIV because they make too much money treating the disease. In some versions people go as far as to say that industry will actively thwart any potential cures to ensure their uninterrupted profit streams.

What is my opinion of this line of thought?

In the spirit of full disclosure, I am a card-carrying anti-capitalist. In my word view, profit is a politically correct word for theft. I very much want to get the profit motive out of medicine, and everything else for that matter.

But in my work as an AIDS activist, my focus is not on overthrowing the world, but advancing the fight against HIV. I work closely with drug companies, meeting with them, sitting on advisory boards, reviewing research programs and even occasionally breaking bread with them.

The ultimate aim of my work is to help in some small way to get us to the cure. So I have given a good amount of thought to this question, and as much as it pains me to say it, I do not think that the pharmaceutical industry is conspiring to keep the cure from us.

To begin, as a whole not that much money is being made in HIV treatment. In the US, where the companies make the most money off of their drugs, HIV is a relatively small and quite crowded market. The long term nature of HIV treatment makes it a somewhat attractive market, but that is balanced our by the relatively small number of people taking HIV drugs, and the large number of products competing for those people.

If the companies were making money hand-over-fist off of HIV drugs, why would they be abandoning HIV research in droves? While I am no expert in the way that companies make investment decisions, if HIV were the plum market so many seem to think it is, I suspect companies would be aggressively moving in to the market, not away.

In fact, only Gilead Sciences makes the bulk of its money off of HIV. The other big players, GSK, Abbott, Roche, Tibotec (Johnson and Johnson), Merck, Pfizer- HIV is a small niche within a vast juggernaut.

Now that is not to say they aren?t making money. They are in the business of making money, and they do this by selling drugs. If they weren?t making money, they wouldn?t be doing it. It is a matter of scale and perspective.

The biggest problem with this line of thinking though is that it treats pharmaceutical companies like a caricature: a cabal of conniving fat cats, secretly conspiring in smoke filled rooms.

In reality they are like any other business people- cut throat competitors. While they will work together on mutually beneficial efforts through their lobbying arm PHARMA, I just don?t see the folks at J and J thwarting one of their own scientists to protect the GSK?s profits.

In fact, there is a powerful economic incentive to cure HIV disease. If a pharmaceutical company develops the cure, they aren?t going to give it away, they will sell it. They will make lots and lots of money off of it. Their competitors won?t. They will also reap a public relations bonanza more valuable than any single drug.

Pharmaceutical companies are made up of regular people- some good, some bad, most somewhere in-between. I don?t work much with the proverbial bean counters, so I fully acknowledge my perspective is incomplete. The folks that I work with are either sales people (often called community relations, but?) or scientists. They are a perfectly ordinary group of people- the sales people are not different than other types of sales people, nor are the scientists substantially dissimilar to their counterparts at NASA or in academia. To a person though they have a sense of the human cost of HIV, and are working if imperfectly on ameliorating its damage. And getting paid to.

When I think about the net effect market capitalism has had on HIV drug development (and trust me I do), I end up agnostic on the question. On one hand I note the tremendous volume of drug development- far outstripping pure market forces- and the overall product improvement, which I know to be in part the result of market forces. I also see how companies jealously guard their products and technologies, effectively slowing and at times thwarting scientific advances.

What I don?t see is conspiracy to keep us on HIV drugs for the rest of our lives. Even Gilead I suspect would be happy to sell us the cure, and go on to making money in other areas. As for the Merck?s and GSKs of the world, they already have their diabetes, high blood pressure and erectile dysfunction drugs to keep separating us from our money for the rest of our lives.