Good morning Hank, it's Tuesday.

So a week from today marks a huge moment of progress for human health as the patent on the drug bedaquiline expires, allowing less expensive generic versions to be produced that can cure far more people living with multidrug-resistant tuberculosis. Wait, what's that? Oh, well that's unfortunate.

What will actually happen next Tuesday is that the company Johnson & Johnson will begin enforcing a secondary patent thus denying access to bedaquiline to around six million people over the next four years. And that's where we come in nerdfighteria because I really think that if we can understand this problem together and make a compelling case to Johnson & Johnson that they are  pursuing a bad business strategy, we can save a lot of lives.

But first some history. Tuberculosis is the world's deadliest infectious disease. It killed about 30,000 people last week, which is especially horrifying given that it is usually curable, generally with a cocktail of drugs given daily over four months. A drug resistant TB that isn't cured by that cocktail is a growing problem, so between the 1940s and the 1960s, we developed and synthesized eight different classes of drugs that could treat tuberculosis. And then, between the 1960s and the end of the 20th century, no new drugs were developed to treat tuberculosis for the simple reason that we stopped investing money in TB treatments because it was no longer a problem in rich countries. Now for the record, if we continue this strategy of global health, caring about infectious disease only when it affects rich countries, we will continue to see more and more drug resistance until eventually a strain of disease emerges that we can't cure, which will spread globally and cause a pandemic which will affect rich countries, and that's one reason to end TB now. Another reason is that all human lives are equally valuable and it's completely unacceptable that, this year, 1.6 million people will die of a curable disease.

Right, so we had these lost decades where we didn't discover any new TB treatments, but then the incentives changed. Governments started to invest much more in research and even in, like, funding trials, making it more interesting to pharmaceutical companies, and eventually Johnson & Johnson developed a new drug called bedaquiline. Now most of the money that went into researching and discovering bedaquiline came from the public, it came from governments, but Johnson & Johnson did take some risks, did invest some money (full credit.) And that's why in 2003, they got to file a patent for the drug compound bedaquiline. Then in 2007, they filed a secondary patent for bedaquiline with this added fumarate salt.

Now, one expert recently explained this to me as filing a patent for a pen cap that goes with your pen. Like a pen cap makes your pen work better and last longer, but it's not the pen. And indeed, Johnson & Johnson always knew that they were gonna have to develop a pen cap for their pen. They waited until 2007 precisely so that they could extend the length of their patent. So bedaquiline becomes available to the public and it has saved hundreds of thousands of lives. Like a couple months ago, I was in Sierra Leone and spoke with two young women who were dying of tuberculosis, who were on their death bed when they received this new cocktail of drugs containing bedaquiline. They quickly recovered. Today, they are cured, they are home with their families, and they are attending school. That's the power of this drug, but while the price of it has dropped over the last decade, it is still way too expensive for many communities. Like, a study by MSF indicated that if generics were allowed to be produced globally, the price of bedaquiline would drop by 67% from a $1.50 a pill to 50¢ per pill.

And that should be happening next Tuesday because the original 2003 patent for bedaquiline expires on July 18th, 2023. But unfortunately, in many countries, Johnson & Johnson is using that secondary patent on the pen cap to extend their exclusivity for four more years. During those four years, experts estimate that up to six million people, who would have access to bedaquiline in a world of generics, won't be able to afford it. And most of those people will die. So if it sounds like I'm angry, that's because I'm angry. But I think we can make change here.

Thanks to lawsuits filed by TB survivors, led by two extraordinary young women, courts have decided that the pen cap is not adequate Innovation, and so they have not granted the patent, which means that there are, right now, generic manufacturers ready to go making bedaquiline. Unfortunately, they won't be able to distribute those generic medications to many countries with a high TB burden, including Sierra Leone. And that's why I'm hoping we come in because we need to explain to Johnson & Johnson that this is a bad decision. Like, Johnson & Johnson is not some evil monolith, it's a company made out of people, and I genuinely believe that most of those people want their work to make the world better. I mean, J&J's corporate credo begins, "We believe our first responsibility is to the patients." And I want them to live up to that credo.

So there are links in the video info below and in a pinned comment to contact Johnson & Johnson, and let them know that you find this attempt to evergreen their patent reprehensible and completely out of line with their credo. There are also links to J&J's social media. Tag them, share the news that bedaquiline's patent should be expiring, saving so many lives, but instead is being immorally evergreened by Johnson & Johnson. Tell your friends about this injustice, tell your family, tell the internet because the only reason Johnson & Johnson executives think they can get away with this is that they think we aren't paying attention in the part of the world where they sell most of their products. Their Band-Aids, their Tylenol, their Listerine. And if you work at Johnson & Johnson or know someone who does, let the company and the executives know about your opposition to the extension of this patent. Tell your bosses, tell your CEO. As I said before, bedaquiline has done so much good and a big part of that good is because of the work that researchers and other people working at J&J put into it.

But the time has come for this drug funded primarily by the public to be returned to the public as a public good. And to the executives of Johnson & Johnson, from one CEO to another, I just wanna make a direct plea. This is a bad business decision. A company's reputation is extremely valuable, and denying bedaquiline to six million people over the next four years will be very bad for your reputation. There are a lot of people who pay a little bit extra for your Neosporin than generic Neosporin because they trust it. And this decision is undermining that trust. Harming those brands is bad business and when you attempt to evergreen a patent, even though you know the decision will cost hundreds of thousands of human lives over the next four years, you're tarnishing your corporate reputation.

I'll quote it back to you, "Our first responsibility is to the patients." I hope you will embrace that promise, and until you do, we will pressure you to live up to your credo. So let's get to work bringing about a world where people no longer die every day for want of bedaquiline. Links below.

Hank, I will see you on Friday.