First we had "Fairtrade" coffee, claiming to help farmers in poor countries. Then came "Penguin Approved" products, carbon neutral to prevent climate change. This week, scientists at Imperial College, London, gave us "ethical pharmaceuticals", claiming they will slash drug prices and save poor countries from disease. Unfortunately, like most "ethical" products, this is more about salving Western consciences than actually helping the poor.

The premise of "ethical pharmaceuticals" is simple: access to medicines is low in poor countries because of the high prices that arise when pharmaceutical companies patent their drugs, giving them a monopoly of those drugs. The scientists claim that by slightly altering the molecular structure of an existing drug they can circumvent the company's patent and market their "new" product at rock bottom prices,thus rescuing the poor from a whole host of diseases.

This all sounds very clever from the comfy laboratories of Imperial College but the philanthropic pharmacists are chasing a red herring. The reality is that the price of medicines is only of marginal relevance to healthcare in poor countries.

Take India. In 1972 it weakened patent laws in the belief that it would drive down the price of medicines. It worked in part, but did it make the Indian people any healthier? The answer is no. Access to even basic medicines in India remains unacceptably low. Children go without routine vaccinations. Simple off-patent anti-infectives are unavailable to the majority of the rural poor. Despite pumping out cheap generic Aids drugs for years, a paltry 12,000 of India's five million Aids sufferers were getting the drugs at the end of last year.

For the Indian poor, the price of drugs is not the issue. The real issue is the state of their healthcare infrastructure.

The government-run system is a shambles, riddled with inefficiency and corruption and lacking resources. The transport network is so bad that rural people struggle to get to a clinic, even if there is one. Meanwhile, dirty water and cooking fuels exact a terrible toll of disease on the poor.

So, when the Indian government decided last year to strengthen its intellectual property laws in order to accelerate India's economic development, the people saw there was no connection between arcane patent laws and the reality of their lives. What they need are hospitals, clinics, doctors and nurses. Without them, you can give drugs away for free and they still won't get to the most needy.

Furthermore, the prices of medicines have not shot up, despite activists' forecasts. Many other countries are just as badly off. In the Philippines, 40 percent of people will never see a doctor in their entire lives. Clinics and hospitals are rare.

This is compounded by counterproductive policies. Last year, the Philippines increased VAT on medicines from 10 to 12 percent and--incredibly--included previously exempt things like doctors' fees: a tax on the sick and dying.

The Philippines is not unique. Most countries in Africa and many in Asia and Latin America have dysfunctional health systems, little health insurance and, most reprehensibly, taxes on medical goods and services--including Brazil and Thailand, campaigners for breaking patents to lower prices.

As a result of these failures of governance, less than 50 percent of people have regular access to essential medicines in much of Africa and Asia.

Activists' fixation with patents and prices only harms patients. Over-hyped schemes such as "ethical pharmaceuticals" take energy and discussion away from the things that really matter, such as infrastructure, doctors, nurses, water management and indoor air pollution. Without improvements there, people will go on dying from easily preventable diseases which already have cheap cures.

As for prices, out of 18 comparable Aids drugs named by Doctors Without Borders in an attack on patents, 14 patented drugs sell below or near the cost of the off-patent generics.

Last July, the head of the WHO's Aids division said: "It is very obvious ... that the elephant in the room is not the current price of drugs. The real obstacle is the fragility of the health systems. You have health infrastructure that is dilapidated, a health workforce that is demoralised, labs that don't work, supply chains that don't exist and diagnostics that are missing."

Improving provision is not easy. But wasting time on prices and patents only diverts attention from governments which damage the health of their poor. We must keep the spotlight firmly on bad governance.

The author is director of the health programme at International Policy Network, a London-based development think tank