March 3, 2004 The Honorable Tommy Thompson
Secretary, Department of Health and Human Services
200 Independence Ave., S.W.
Washington D.C. 20201

Dr. Mark Rohrbaugh
Director of the Office of Technology Transfer
Office of Intramural Research
National Institutes of Health
6011 Executive Blvd, Suite 325
Rockville, MD 20852

Dear Secretary Thompson and Dr. Rohrbaugh:

The undersigned clinicians write in strong support of the March-In petition filed last month by the nonprofit Essential Inventions, Inc., for an open license for the supply of ritonavir, sold by Abbott Laboratories as Norvir=AE. An open license would allow full and open competition for the supply of ritonavir, which we believe is a fitting remedy to abusive pricing practices of Abbott Laboratories.

There is widespread dissatisfaction among HIV health care providers nationwide with Abbott Laboratories regarding the decision to increase the price of ritonavir by more than 400%. This increase, if allowed to stand, will have devastating consequences for the future of HIV care in the United States.

Ritonavir is the only effective boosting compound available to increase the effectiveness of existing treatments for HIV/AIDS. Without ritonavir, other compounds are dramatically less effective. Ritonavir is an essential component of almost every protease inhibitor-based antiretroviral treatment for HIV/AIDS.

Abbott's price increase effectively makes its Kaletra product, which includes ritonavir and was not subject to the price increase, the cheapest boosted protease inhibitor on the market. This will have adverse consequences for the care of patients as doctors and patients will feel pressure to use Kaletra, even when it is not the best treatment for a patient.

There is no legitimate justification for Abbott's 400% increase in the price of ritonavir, announced just two weeks before Christmas. Abbott is taking advantage of a monopolistic situation, where its product is the only effective protease inhibitor boosting agent.

We are shocked and dismayed that Abbott has raised the price of ritonavir in the U.S., where taxpayer dollars funded its discovery, but not in Europe and other wealthy countries. This fact hardens our opinion that Abbott's price increase lacks any legitimate justification. At least when U.S. taxpayers fund the discovery of a medicine, they should not be subject to arbitrary and discriminatory prices out of proportion with the prices for the same drug in other comparable markets.

We encourage you to act to remedy this dire situation. Abbott is not making this important government invention available to the public on reasonable terms. Your action is needed to protect the health and safety of people with HIV/AIDS from the effects of Abbott's abusive price increase.

Sincerely,

Benjamin Young, M.D., Ph.D.
Phone: 303-829-4553
E-mail: DenverIDC@aol.com


1. Douglas Ward, M.D.
2. James L. Dean, M.D., FACP
3. Howard Grossman, M.D.
4. Margot Schwartz, M.D.
5. Gary Blick, M.D.
6. Jacob Lalezari, M.D.
7. Jason Barker, M.D.
8. Kenneth Greenberg, D.O., Pharm.D.
9. Larry J. Wardzala, M.D., Ph.D.
10. Gerald Pierone, M.D.
11. Daniel E. Cohen, M.D.
12. Bryan J. Marsh, M.D.
13. Winston Cavert, M.D.
14. Harold L. Martin, Jr., M.D., M.P.H.
15. David Moore, D.O.
16. Patricia L. Hogan, A.R.N.P.
17. Dan Warner, M.D.
18. Margaret Hoffman-Terry, MD, F.A.C.P.
19. Zelalem Temesgen, M.D.
20. William F. Owen, Jr., M.D.
21. Mitchell V Brodey, M.D.
22. Sapphire Mann Ahmed, M.D.
23. Luis Marquez, M.D.
24. Jason Sneakers, M.D.
25. Barbara Johnston, M.D.
26. Bruce Rashbaum, M.D.
27. Ian Gilson, M.D., F.A.C.P.
28. Bob Schwartz, M.D.
29. Carl Owen, M.D.
30. Peter Shalit, M.D.
31. Yusuf Erskine, M.D.
32. Jeffrey L Horstmyer, M.D.
33. Greg Sauers, PA-C
34. Clifford Kinder, M.D.
35. David Parks, M.D.
36. Dorothy E. Bulgin-Coleman, M.D.
37. Brady Allen, M.D.
38. Alan J. Wright, M.D.
39. Edwin DeJesus, M.D.
40. Marah J. Lee, II, D.O.
41. Mark Hupert, M.D.
42. Jennifer Ramin, ANP
43. David M. Lee, M.D.
44. Mary van den Berg-Wolf, M.D.
45. Bridget Stringer, M.P.A.S., PA-C
46. Ellen M. Tedaldi, M.D.
47. Ronald Schut, M.D.
48. Jeffrey A. Beal, M.D.
49. Corky Steinhart, M.D.
50. Susan M. Graham, M.D., M.P.H.
51. Alexander Granok, M.D.
52. Jon Appelbaum, M.D.
53. Danny Toub, M.D.
54. J. Kevin Carmichael, M.D.
55. Christopher Behrens, M.D.