76.来自华盛顿特区国家卫生保健管理研究所发布的年度报告。
77.1997年至1998年间，全球药品销售前三的国家如下表：
就制药公司在世界市场的销售额而言，细分为：
See: Morrow, D. J., “Worldwide drug sales up 7% in '98.” New York Times (March 23,1999): C5.
78.Tanouye, E., 1998, op. cit. In this excellent Wall Street Journal analysis the reporter notes that the U.S. market was driving not only profits but also all industry research and development plans.
79.20世纪末，医疗保险提供商和健康维护组织报告说，药费已经超过了住院治疗的总开支……并预计这一数字将在21世纪头十年急剧上升。例如，在美国，政府估计药品的公共支出总额将从1998年的743亿美元猛增至2007年的1711亿美元。药品在卫生支出中所占的比例，在1980年仅占4.9%，1998年为6.5%，到2007年将达到8%。.
80.Armstrong, K., Schwartz, J. S., and Asch, D. A. “Direct sale of Sildenafl (Viagra) to consumers over the Internet.” New England Journal of Medicine 341 (1999): 1389-92; Ostrom,C. M., “Internet medicine opens can of worms: Tremendous potential good—and harm.” Seattle Times (May 12, 1999): A1; and Stolberg, S. G., “The boom in medications brings rise in fatal risks.” New York Times (June 3, 1999): A1.
81.Murray, C. J., and Lopez, A. D., The Global Burden of Disease. Geneva: World Health Organization, 1996.
82.See: Murray, C. J. L., and Lopez, A. D., “Global mortality, disability, and the contribution of risk factors: Global Burden of Disease study.” Lancet 349 (1997): 1436-42; and“Spirit of the age.” The Economist (December 19, 1999): 113-17.
83.Tanouye, E., 1998, op. cit.
84.Trouiller, P., “R & D drug development trends.” Conference on Drugs for Communicable Disease, Paris, October 14-15, 1999; and Silverstein, K., “Millions for Viagra,pennies for diseases of the poor.” The Nation (July 19, 1999): 13-19.
85.Ibid.
86.Bale, H., and Kettler, H. E., “Industry's role in meeting the need for CDC-specifc medicines.” Conference on Drugs for Communicable Diseases, Paris, October 14-15, 1999.
87.Given by the pharmaceutical Research and Manufacturers of America.
88.据美国制药研究机构和制造商提供的资料。
89.Wunsch, H., “Expert warns of possible poliomyclitis vaccine shortfall in 2000.”Lancet 355 (2000): 728. And Associated Press. “Vaccine price prompts shift.” New York Times(February 17, 2000): A23. And Pecoul, B., Chirac, P., Trouiller, P., and Pinel J., “Access to essential drugs in poor countries: A lost battle?” Journal of the American Medical Association 281 (1999): 361-67. And Yudkin, J. S., “Insulin for the world's poorest countries.” Lancet 355(2000): 919-21. And Silverstein, K., “Millions for Viagra, pennies for diseases of the poor.” The Nation (July 19, 1999): 13-19.
90.1999年1月，作者的访谈记录。
91.Aventin, L., “Trade agreements and public health: Role of WHO.” Lancet 355(2000): 580.
92.Price, D., Pollock, A. M., and Shaoul, J., “How the World Trade Organization is shaping domestic policies in health care.” Lancet 354 (1999): 1889-92.
93.据斯德哥尔摩国际和平研究所统计，1991年后国防开支总体在下降，1988年至1998年的下降幅度为30%。超过1/3的国防总开支减少是在美国（1997年为2590亿美元）。排在第二位的是日本，只花了500亿美元。排名前20位的发展中国家有沙特阿拉伯（190亿美元）、韩国（180亿美元）、巴西（160亿美元）和印度（110亿美元）。
94.在这一点上的记录好坏参半，但世界卫生专家的普遍共识是，从长远来看，药物捐赠并不奏效，例如河盲症、血吸虫病、疟疾、沙眼和丝虫病。自1974年至1999年间，药品制造商都向世界卫生组织提供一种治疗性或预防性产品用于上述每一种疾病的治疗。这些产品要么是免费提供，要么是非常廉价。药品的分配任务则交给了世界卫生组织和相关地方政府，结果显然好坏参半，河盲的治疗被证明是最成功的。默克制药公司在20世纪70年代早期开发了一种名为伊维菌素的兽药。当这种药物被证明可以完全治愈由盘尾丝虫感染导致的寄生虫病后，1974年，世界卫生组织与默克公司达成了一项具有里程碑意义的协议，即允许默克公司提高伊维菌素作为兽药的盈利，以此抵消公司免费向世界卫生组织捐赠供人类使用该药的成本。1999年，在世界银行资助下，历经25年的艰辛，西非国家坚持把药物送到了该地区受灾最严重的偏远农村，几乎消除了河盲症。遗憾的是，即使坚持了25年的努力，这项工作在2000年还没有结束。
其他项目的成功率要低得多。失败是由许多因素造成的。不过，毫无疑问的一点是，所有这些因素都与受影响地区本身的公共卫生和初级卫生保健质量低下有关。靠捐赠药物的方式来消除病患是治标不治本。例如，在埃及，捐赠的吡喹酮不能彻底消灭血吸虫病，除非尼罗河及其支流的寄生虫生命周期也被打乱，进而在整个大环境中消灭血吸虫。其他药物捐赠项目在短时间内确实降低了疾病的发病率，但当治疗费用或公共卫生基础设施等基本需求无法得到保证时，这些项目就变得不可持续了。疾病随即卷土重来。
最后，并非所有制药公司的慈善都是慷慨无私的。例如，世界卫生组织发现，在1999年科索沃难民危机期间，阿尔巴尼亚卫生部收到的108批捐赠药品中，有“大约50%的捐赠只提供了商品名，且其中有许多药品是当地卫生专业人员所不熟悉的；另外，只有56%的产品标注了保质期信息，其中约41%的药品剩余保质期不到一年，还有18%的医药捐赠品中有小包装的免费样品或是退回药店的药品。”
95.Zuger, A., “Type of penicillin is in critical supply.” New York Times (October 29,1999): A20.
96.Rosamond, J. and Allsop, A., “Harnessing the power of the genome in the search for new antibiotics.” Science 287 (2000): 1973-76.
97.World Health Organization. “Removing obstacles to health development.” World Health Organization, Geneva, June 17, 1999.
98.UNAIDS. “UN leaders call AIDS in Africa a massive development catastrophe.” Lusaka,Zambia, September 13, 1999.
99.1999年1月，作者的访谈记录。
100.1999年1月，作者的访谈记录。
101.National Intelligence Council. “The global infectious disease threat and its implications for the United States.” Central Intelligence Agency (January 2000): NIE-99-17D.
102.Balter, M., “French-led therapy fund kicks off in Africa.” Science 284 (1999): 1101;Dowell, W., “Ethics and AIDS drugs.” Time (July 12, 1999): 49; and Mabry, M., “No money,no meds.” Newsweek (July 12, 1999): 32-33。虽然许多发展中国家确实有足够的基础设施，能够适当地分发延长生命的药物，用于治疗艾滋病患者的机会性感染，如结核病、肺孢子虫肺炎和隐球菌性脑膜炎。但他们也直截了当地反对与贸易有关的知识产权、专利法以及定价不平等。见：Wilson, D., Cawthorne, P., Ford, N., and Aongsonwang, S., “Global trade and access to medicines: AIDS treatments in Thailand.” Lancet 354 (1999): 1893-95。
103.Fisher, I., “Malaria, a swamp dweller finds a hidden home.” New York Times (July 21, 1999): A4; White, N. J., Nosten, F., Looareesuwan, S., et al., “Averting a malaria disaster.”and Letters in response. Lancet 353 (1999): 1965-67 and 354 (1999): 1389-90.
104.Attaran, A., “Respective public and private sector contributions to the development of new drugs.” Drugs for Communicable Diseases Conference, Paris, October 14-15, 1999;Helenport, J. P.“The development and registration of artemisinin derivatives, a triangular development.” Drugs for Communicable Diseases Conference, Paris, October 14-15, 1999;Jomaa, H., Wiesner, J., Sanderbrand, S, et al.“Inhibitors of the nonelevating pathway of Isoprenoid Isoprenoid biosynthesis as antimalarial drugs.” Science 285 (1999): 1573-76;etc..
105.Centers for Disease Control and Prevention.“Primary multidrug- resistant tuberculosis—Ivanovo Oblast, Russia, 1999.” Morbidity and Mortality Weekly Report 48 (1999):661-64.
106.Kim, J. Y., Farmer, P., and Dahl, O., Letter to Partners in Health, September 18,1997.
107.Rifampicin, isoniazid, pyrazinamide, and either ethambutol. or streptomycin.Either rifampicin or ethambutol combined with isoniazid. Murray, C. J. L., “Results of directly observed short-course chemotherapy in 112,842 Chinese patients with smear-positive tuberculosis.” Lancet 347 (1996): 358-62.
108.Blanc, D. C., “Incentives and disincentives for new anti-tuberculosis drug development.” World Health Organization, Geneva, November 1998.
109.World Health Organization. The World Health Report 1998. World Health Organization, Geneva, 1998.
110.Centers for Disease Control and Prevention.“Tuberculosis elimination revisited:Obstacles, opportunities, and a renewed commitment.” Morbidity and Mortality Weekly Report 48 (Supplement) (1999):RR-9.
111.Program in Infectious Disease and Social Change. The Global Impact of Drug-Resistant Tuberculosis. Open Society, New York, 1999. (Available in full on-line at www.opensociety.com.)
112.MRSA：耐甲氧西林金黄色葡萄球菌，VRE：耐万古霉素肠球菌，VISA：万古霉素不敏感金黄色葡萄球菌。
113.1998年，作者的访谈记录。
114.Bloom, B. R., Bloom, D. E., Cohen, J. E., et al.,“Investing in the World Health Organization.” Science 284 (1999): 911; “Smokescreens.” The Economist (March 14, 1998):91-92; “WHO steps closer to its responsibilities.” Nature 398 (1999): 175; “WHO: Where there is no vision, the people perish.” Lancet 350 (1997): 749.
115.Brundtland, G. H., “WHO—The road ahead.” Speech to the World Health Organization Executive Board, Geneva, January 24, 1999; and World Health Organization. The World Health Report 1999. World Health Organization, Geneva, 1999.
116.1996年9月，作者的访谈记录。
117.See previously cited Murray, C. J. L., references and Garrett, L., “The future of death.” Newsday (October 8, 1996): B21.
118.See also: “From what will we die in 2020?” Lancet 349 (1997): 1263; Husten, L.,“Global epidemic of cardiovascular disease predicted.” Lancet 352 (1998); 1530; Lee, W. C.,“Quantifying the future impact of disease on society: Life table-based measures of potential life lost.” American Journal of Public Health 87 (1997): 1456-60; Murray, C. J. L., and Lopez, A.D., “Alternative projections of mortality and disability by cause 1990-2020: Global Burden of Disease Study.” Lancet 349 (1997): 1498-1504; etc..
119.Armstrong, G. L., Conn, L. A., and Pinner, R. W., “Trends in infectious disease mortality in the United States during the 20th century.” Journal of the American Medical Association 281 (1999): 61-66. See also McGinnis, J. M., and Foege, W. H., “Actual causes of death in the United States.” Journal of the American Medical Association 170 (1993): 2207-12.
120.National Intelligence Council, op. cit, 2000.
121.World Health Organization. Removing Obstacles to Healthy Development. World Health Organization, Geneva, June 17, 1999.
122.De Kruif, P., 1936, op. cit.
123.Nadis, S., “U.S. concern grows over secrecy clauses.” Nature 398 (1999): 359;Cimons, M., and Jacobs, P., “Biotech battlefield: Profits Vs. public.” Los Angeles Times (February 21, 1999): Al
124.Reich, M. R., “The global drug gap.” Science 287 (2000): 1979-81; Enserink, M.,“Group urges action on Third World drugs.” Science 287 (2000): 1571; Kasper, T. “Global patent police block cost-reduction efforts.” Treatment Issues 13 (1999): 1-2; Orbinski, J.,“Speech on acceptance of the 1999 Nobel Peace Prize.” Médecins Sans Frontières, Oslo,December 14, 1999.