Another episode in the recurring conflict between public need and private profit played out this week when Johnson & Johnson declined to contribute three drugs to the Medicines Patent Pool, which seeks to combine patents so that generic manufacturers can produce cheaper HIV/AIDS drugs for use in under developed nations.

An Inquirer story on it is here.

The conflict is that private companies are supposed to try to make money. Most investors buy stock in hopes the company will pay dividends and that the value will rise in case of a future sale. Indeed, stockholders, generally, would like to make as much as possible. And then the employees, from the chief executive officer on down, want to make money, too. But the public good might be served by donating drugs or the patents protecting the drug profits, to help treat and save those who can't afford the drugs otherwise.

Another element is that every patient -- and advocacy group -- thinks their disease is the most important. Yes, there are grades of that, but it's natural and unlikely to disappear anytime soon.

But if Corporation X gives away every drug for every disease, the profit will slip or disappear. How much will vary, of course. Companies say they need high profits to pay for research and development.

Doctors Without Borders, which works with the Medicine Patent Pool, goes to many of the worst spots in the world to treat patients with AIDS, diseases and other ailments.

"We are locked in a mechanism," said Judit Rius San Juan, U.S. manager for the Doctors Without Borders Access Campaign. She wasn't happy with the mechanism. "Pharmaceutical companies say, 'We have to keep high prices to pay for R&D.' But there has been a lot of conversation within the World Health Organization about changing the equation so we can provide medicines without charging such high prices."

Finding a new mechanism will be a challenge, regardless of the state of world and national economies.