[e-drug] Medicines for rich patients only? 13th March Deccan Herald

e-drug
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E-DRUG: Medicines for rich patients only? 13th March Deccan Herald
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Posted by
Dr Gopal Dabade,
57, Tejaswinagar,
Dharwad 580 002,
INDIA
Dr Gopal Dabade <dabadedr@yahoo.com>

http://www.deccanherald.com/content/391614/medicines-rich-patients-only.html

Medicines for rich patients only?
Gopal Dabade, Mar 13, 2014 :
Cost of medicines is the most debated topic even among civil society members and several heads of governments.

Modern medicines play an important role in saving lives and also in improving quality of life. Not many know that vast majority of people do not have access to life saving medicines. There exist many reasons for this, the most important being high cost of medicines. It might surprise most to know that the cost of medicines is the most debated topic not only among international business community members but even among civil society members and several heads of governments. Why does drug pricing attract such huge attention? Primarily because unlike other commodities in the market, the same drug in the same dose when manufactured and sold by two different companies shows huge, unbelievable price differences.

Let it be made clear by giving an example. The drug sorafenib sold under its trade name 'Nexavar' manufactured by the Germany based multinational drug company Bayer costs Rs 2.8 lakh per month for a person, whereas exactly the same drug when manufactured by the Hyderabad based Indian generic drug company Natco Pharma Limited, sold under its trade name 'Sorafenata' costs Rs 8,800 per month for a person . A huge price difference of 97 per cent! It should be noted here that the Indian generic company is also making a good profit.

Many times, the news that medicines can be made available at such affordable price has spread globally like wildfire because most governments (both developing or developed) are trying to examine as to how health-care can be made affordable. Much credit for this effort should go to the Indian generic industry. People were delighted that medicines can now be made easily available and thus more lives could be saved. But the joy was short lived because Bayer was perceptibly upset. Its chief executive officer (CEO), Marijn Dekkers issued a statement that stunned the world. He said 'We did not develop this medicine (Nexavar) for Indians, adding, 'We developed it for western patients who can afford it.' Dekkers further called the Indian regulator's action as 'essentially theft'. 

Everything wrong

This statement of Bayer chief was shot down by Doctors Without Borders (Medicines Sans Frontiers – MSF) by saying that it summed up everything that was wrong with the multinational pharmaceutical industry. MSF is an independent international medical humanitarian organisation that delivers emergency aid in more than 65 countries to people affected by armed conflict, epidemics, natural or man-made disasters or exclusion from healthcare.

Not only Bayer but all the multinational drug companies of Europe and America stood up and brought pressure on the American government to trouble Indian government with regard to India's Intellectual Property Laws. Just look at this: The US International Trade Commission (USITC) has launched an investigation to examine a wide range of Indian policies that discriminate against US trade and investment. This investigation on 'Trade, investment and industrial policies in India: Effects on the US Economy,' was requested jointly by the Senate committee on finance.

Why was all this happening? To get an answer to this question we need to know about Bayer and the drug Nexavar. Bayer is globally present with companies in almost every country all over the world. Its financial powers are just beyond anyone's imagination. In fiscal year 2012, Bayer employed 110,000 people and had sales of €39.7 billion. The medicine Sorafenab has been found to be useful in treating cancer of kidney and liver. The drug was discovered by Bayer and has been patented in most countries all over the world including India in the year 2008. So Bayer held the absolute power to dictate the price of the drug till 2020. But on March 9, 2013 the government of India's patent office at Chennai (IPAB - Intellectual Property Appellate Board) issued Compulsory

Licensing (CL) breaking the monopoly of Bayer.

This meant that drug could be manufactured by another company even though Bayer had patents. It is this in particular that has annoyed Bayer. Is it wrong for India to do this? An emphatic 'No' says an article in the prestigious medical magazine Lancet of February 2014 titled, 'The political origins of health inequity: prospects for change' It says 'The Sorafenib case is not only a story of one drug and one country's patent law, but also a flashpoint in a long-running global political contest over how certain types of health-related knowledge are produced, and who benefits. Even countries that traditionally embrace strong intellectual property rights at times use the threat of a compulsory licence, as the USA did in 2001 for drugs against anthrax”.

But then why is US bullying India now? When will the Big Brother change?

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E-DRUG: Medicines for rich patients only? 13th March Deccan Herald (2)
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Hi,
It has been the practice of bullying big nations to bother the weaker countries on some or other pretext. In these instances it is medicine patents, pricing, profitability of the powerful who wish to ensure that the poor populations do not enjoy the fruits of newer medicines. Exorbitant prices of newer patented medicines ensure non affordability to the marginalized populations and such manufacturers boast that such medicines are meant for the rich!

Marginalized economies will do well to fight this discriminatory exploitation by organizing and standing up against the big bullies. They should get together and use the expertise of the developing economies to share the expertise to manufacture affordable alternatives and make these available to their needy patients. The companies which propagate that their medicines are for rich only should be asked to leave the developing economies. Let them go and do the business only in rich countries.

The law of the land should be amended that if fruits of their research does not benefit the national populations, such pharmaceutical companies should not be given the benefits of saving on taxes in the name of research expenditure. What good are such exemptions if these companies do not exist for the welfare of marginalized ? After all tax exemptions in the name of research take away the taxes which otherwise if collected, can be used for national expenditure. By allowing such research tax haven to pharmaceutical companies for research expenses, neither the populations enjoy the fruits of their research nor get the benefit of development which otherwise could come to them through taxes collected.

Big brothers take care, protect, look after the younger ones and do not bully them. Hence reserve and preserve that for the deserving. Bullies are not big brothers!

Professor Dr Vijay Thawani, India

Dr Vijay Thawani,
Professor of Pharmacology,
Shri Guru Ram Rai Institute of Medical Sciences & Health, Patel Nagar,Dehradun-248001, Uttarakhand.
"Vijay Thawani" <vijaythawani@rediffmail.com>

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E-DRUG: Medicines for rich patients only? 13th March Deccan Herald (3)
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Hello,
This story makes sad reading. One wonders what is happening to the concept of Corporate Social Responsibility ( or corporate conscience) where business is carried out in the spirit of three P's namely Profit, Planet (environment) and People (social).

A company that charges exorbitant prices for its product can not be said to be socially responsible.
Maybe WTO needs to come in to regulate this aspect of pharmaceutical business. Then the buying organizations or countries too should find a way of enforcing responsible (reasonable) pricing in whatever small way they can

Abel
Abel Livingi
Pharmacist
Zambia
"Livingi Abel" <livab2000@yahoo.com>

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E-DRUG: Medicines for rich patients only? 13th March Deccan Herald (4)
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[The development and maintenance of national legislation and other mechanisms that ensure access to the TRIPS flexibilities are important strategies for ensuring access to newer expensive medicines. BS]

Dear colleagues,
'Medicines for rich patients only' suggests that pharma industry is 'chasing' after the money. But that is commerce, business, enterprise. To suggest that commerce must hold any other position, is I gather stretching corporate position.

However, as the moderator indicated earlier, we should be looking at how best to engage pharm industry to ensure that public health retains access to those (cheap?) medicines that are needed by the majority of people. Other sectors of health, for example, global immunization programme, have demonstrated that such a working arrangement, leading to access to basic vaccines, is possible and is workable.

As we speak about 'expensive' medicines, increasingly, developing countries are facing the prospect of providing high-cost tertiary care, and doing so as part of the basic package of care (ie, moving beyond primary healthcare). In that regard, developing countries have to access expensive pharmaceutical products and to include those on their national essential drugs list. Products that we think as 'for the rich' will have to be on that list, to treat diseases that are now increasingly common, that are increasingly becoming a fact in society (eg, those classified under non- communicable diseases, referred to as 'lifestyle' diseases.. which make one wonder if we can call these as diseases of the rich?).

So, in this scenario, we should expect pharma industry to gravitate towards providing these expensive medicines. However, to serve the interest all of public health, governments and others must come up with an engagement strategy that would ensure that both basic and 'expensive' medicines are affordable. As the moderator has stated, we do need pharma industry, but as a business, pharma businesses will also go for the money.. first?

Regards,
Bonnie

Bonface Fundafunda PhD., MBA., B.Pharm
Managing Director,
Medical Stores Limited
P.O. Box 30207
Mukwa Road, Plot 6446
Lusaka,
Zambia
Tel (Dir): +260 211 246510 (Dir)Tel (General): + 242768/ 244105 / 242346
Fax: +260 211 246288
Mobile: + 260 979 25 29 00
Email: bonface.fundafunda@medstore.co.zm
Web: www.medstore.co.zm

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E-DRUG: Medicines for rich patients only? 13th March Deccan Herald (5)
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All the major companies have as part of their mission statements and values serious wording about helping the poor, global health inequalities, assuring access to those in need and so forth. It would be useful to collect these, discuss them, and compare them. So colleagues dismiss them as written by the public relations department; but I think one should hold them to their stated values and missions.

This kind of exercise provides the basis for stating how and to what extent companies are "institutionally corrupt," that is, corrupt their own values and mission.

With best regards,

Don