
‘Pharmacy of the developing world’ under attack from the US, EU, Japan - shekhar101
http://handsoff.msf.org/generics-under-attack
======
myth_buster
The ominous quote "This is just the beginning" seems apt here.

TPP bill [0] which is being negotiated in secret will result in more sustained
damage [1].

Since R&D will be the single most critical argument, this table [2] could
highlight it's fallacies.

[0] [https://www.eff.org/issues/tpp](https://www.eff.org/issues/tpp)

[1] [http://www.doctorswithoutborders.org/news-
stories/briefing-d...](http://www.doctorswithoutborders.org/news-
stories/briefing-document/trading-away-health-trans-pacific-partnership-
agreement-tpp)

[2] [http://i.imgur.com/3kmBKcS.png](http://i.imgur.com/3kmBKcS.png)

~~~
oneJob
Timely. I'm reading "The Truth About the Drug Companies" by Marcia Angell. Per
Wikipedia, Dr. Angell is "the first woman to serve as editor-in-chief of the
New England Journal of Medicine. She is currently a Senior Lecturer in the
Department of Global Health and Social Medicine at Harvard Medical School in
Boston, Massachusetts". So, a good person to write a book on the issue.

Just one more example of how drug companies are taking their customers for a
ride. Knowing that a drug has a finite patent life, a drug company will
stagger the release of two drugs that are pharmacologically similar by patent-
wise different. The drug company will introduce an "improved" drug (which
we'll refer to as "nu") just as the old drug's (which we'll refer to as "pro",
as in before) patent is about to expire. This is accompanied by pricing
tactics such as raising the price of the "pro" drug above the "nu" drug so as
to incentivize patients to switch, paying generic-producing companies not to
make it, and giving hospitals preferential pricing on the "nu" drug so that it
is prescribed at hospitals but then patients pay the higher rate when they go
home. One of the most insidious effects of this strategy is that, the drug
company is either purposely pricing people out of medicine they need or
knowingly selling an inferior product for a decade or more.

Highly recommend reading this book if interested on this subject:
[http://www.nybooks.com/articles/archives/2004/jul/15/the-
tru...](http://www.nybooks.com/articles/archives/2004/jul/15/the-truth-about-
the-drug-companies/)

~~~
delinquentme
"How is the pharmaceutical industry responding to its difficulties? One could
hope drug companies would decide to make some changes—trim their prices ..."
It seems this, extrapolation, or "logical next step" well encapsulates what
the writer knows on the topic of pharma. On what planet would one derive this
conclusion from the precursor of lessening profits?

------
theworstshill
The piece at the very end is enlightening:

"SWISS PHARMACEUTICAL COMPANY NOVARTIS first took the Indian government to
court in 2006 over its patent law because Novartis wanted a more extensive
granting of patent protection for its products than offered by Indian law. The
company had been refused a patent in India on a cancer drug it produces. In a
first case before the High Court in Chennai, Novartis claimed that the Act did
not meet rules set down by the World Trade Organization and was in violation
of the Indian constitution. Novartis lost this case in 2007, but launched a
subsequent appeal before the Indian Supreme Court in a bid to weaken the
interpretation of the law and empty it of substance. All of Novartis’s claims
were rejected by the Supreme Court in a landmark decision announced on 1
April, 2013."

So much for world trade organization benefiting the world through more
competition and a lowering of prices. Fuckers.

------
rickdale
This is funny because I am literally on the phone with my bank to get them to
lift the block on the charge for indian provigil. I didn't realize this was a
big thing, but I am excited to try the provigil. I did ask my doctor for it
for what its worth, but he said its too expensive to prescribe to me. I don't
have insurance...

~~~
MagicWishMonkey
I don't think it's legal to import prescription drugs from overseas, FYI. So
it might not be a good idea to discuss the transaction with your CC provider.

~~~
ekianjo
> I don't think it's legal to import prescription drugs from overseas, FYI. So
> it might not be a good idea to discuss the transaction with your CC
> provider.

Doctors can import prescriptions drugs from other countries if they wish too,
with a special import form to justify the exception.

~~~
1971genocide
Wow ! You cannot order any drug you want from overseas in American ? It seems
like a blantent violation of basic freedom.

~~~
PietdeVries
That's the whole idea of patents, isn't it? Just like you can't import
medicine that infringes patents you also cannot parallel import iPhones or
start making jeans and attach a Levi's tag to it...

edit @aikah: ok, point taken. You recall the issues Apple and Samsung had with
the one phone looking like the other? Fighting on the streets and in court to
prove that the edges were different or the home button is not the same?
Patents are valid for phones, then why not for medicine? Because lives are
involved? That seems a slippery argument - next animal life is endangered or
quality of living is impacted: where does it stop?

It's not possible to start making exceptions, because there is always someone
with a tear-jerking story who is impacted by not being excepted too...

~~~
aikah
> That's the whole idea of patents, isn't it? Just like you can't import
> medicine that infringes patents you also cannot parallel import iPhones or
> start making jeans and attach a Levi's tag to it...

That's not a good analogy. one could make an phone that has the exact same
specs as the iphone or jeans that is the exact replica of a Levi's ,without
the brand and the logo on it and it would not be an iPHone or a Levi's Jean.

it might not be legal but it wouldn't be shocking. The fact that you can't
reproduce a formula ... TO SAVE LIVES ... is shocking.

US government prefers people dying because they can't afford meds rather than
violating something that has nothing to do with the free market, ie , patents.
We're not talking about phones or clothes here , we're talking about
medication people's life depend on.

~~~
tsotha
>That's not a good analogy. one could make an phone that has the exact same
specs as the iphone or jeans that is the exact replica of a Levi's ,without
the brand and the logo on it and it would not be an iPHone or a Levi's Jean.

I'm not sure this is true. You'd likely fall afoul of one of Apple's design
patents (like the famous "rounded corners" patent).

------
saosebastiao
Drug companies do a great job at developing drugs, but then turn around and
spend twice as much marketing them. Doesn't it seem like it would be a better
system if government(s) set up drug development bounties, and pay the bounty
in exchange for the patents? Drugs immediately gain generic availability, and
the drug companies no longer need to sell their shit with Super Bowl
commercials in order to make a profit.

~~~
tsotha
Drug companies do spend a lot of money on marketing, but not every drug is the
same. The ones you see on Superbowl commercials are usually drugs you don't
_need_ , like mild pain killers and allergy medications. My suspicion is the
only reason these kinds of drugs aren't OTC is this way the drug company can
get your insurance to pay.

I doubt they spend much marketing drugs to treat cancer or AIDS.

------
ksk
The science that these drugs are based on was given to the public domain for
free by scientists all around the world throughout history. Lets see if these
greedy companies are willing to pay those scientists whose results they freely
use.

Knowledge that helps save lives should not be under copyright (nor should it
be a for-profit enterprise, but that is a separate argument).

~~~
JoeAltmaier
The free market has been pretty efficient at inventing lifesaving gadgets and
processes. They are protected by patent and copyright. Its arguable they
wouldn't exist otherwise.

Its a lazy view that 'everything we need should be free' that ignores basic
facts about invention and innovation.

~~~
ksk
If we're being generous - your argument is weak. Most governments _heavily_
subsidize core scientific research through public funds. It is decidedly NOT a
free market. The free market has always been horrible at anything to do with
public good.

>Its a lazy view that 'everything we need should be free' that ignores basic
facts about invention and innovation

Nobody said that.

~~~
JoeAltmaier
Oh come on -

    
    
       "Knowledge that helps save lives should not be under copyright (nor should it be a for-profit enterprise, but that is a separate argument). 

"

That's what I was getting at. Devices and processes are what patents are for,
for a reason. Scientific research - ok, that's a different beast. I probably
changed the subject there, sorry.

------
forrestthewoods
Of course they are. In the United States you also can't import cheap generic
from Canada. Most intellectual property law is recognized and enforced
internationally. Everyone on this board has a career because of IP law.

We have a globally broken system in that America subsidizes the world
medicinally. American companies research and develop many (not all) drugs.
Americans then pay out their asshole for those drugs. Other countries then get
to make those drugs for "free". Not free free. But they get to ignore the R&D
costs.

Eventually the camel's back will break. Research costs will become too high
for 300m out of 7b to pay for. Then we can figure out a new system that works
better. This is probably a good thing. I don't know what the system looks like
though. No one does.

~~~
myth_buster

      Americans then pay out their asshole for those drugs. Other countries 
      then get to make those drugs for "free". Not free free. But they get to 
      ignore the R&D costs.
    
      Eventually the camel's back will break. Research costs will become too 
      high for 300m out of 7b to pay for.
    

This "Drug industry scare card" is easily refuted [0] (check the table).

    
    
      But as the table below shows, drug companies spend far more on 
      marketing drugs - in some cases twice as much - than on developing 
      them. And besides, profit margins take into account R&D costs.
    

[0]
[http://www.bbc.com/news/business-28212223](http://www.bbc.com/news/business-28212223)

~~~
forrestthewoods
Few people dispute that it costs a billion dollars or so to bring a new drug
to market. That's a heavy cost foreign manufacturers don't have to pay.

The fact that marketing is a higher spend is irrelevant. It's like free2play
on mobile. You spend a bunch of money developing something. If you can spend
$.90 in user acquisition to earn back $1.00 then you throw every single dollar
you can muster so long as the benefit is higher than the cost. It's a
diminishing returns equation so you do as long as you can. The highest
grossing games have marketing campaigns on the order of $100,000,000.
Basically the same thing here. Take out as many loans as you can so long as it
works.

~~~
pavedwalden
I'm not saying you're wrong, but it struck me as funny to see a much-
criticised practice in the pharmaceutical industry being defended by comparing
it to F2P mobile games, which are also widely reviled.

~~~
forrestthewoods
Hah. I'm no fan of the f2p mobile gaming industry myself. But the math is very
straight forward there. It exists for non-f2p games as well but it's less
obvious and clear.

------
dandare
I call your hypocrisy.

Drug trials are expensive and the ROI is not stellar at all. Without the
prospect of copyrighting the result there would be way less efficient yet safe
drugs for all of us. As a fact pharma companies - despite the conspiracy - are
nowhere the biggest or richest companies of the world (Pfizer roughly #48). So
why did you decide that actually pharma companies - and not for example YOU -
should sponsor the treatment of the poor of this world? Do you equally expect
Nestle to feed the hungry for free because it produces food?

~~~
ivanca
This is about IP. Not about a limited resource like food. And is very easy to
understand economically: is the same reason why in Finland and other countries
traffic tickets amounts are based on the income of the driver, following the
same logic costs of drugs should be tied to the ability of a country to pay
them.

TL;DR you can't pretend asking $1.000 to an American is the same as asking
$1.000 from a Nigerian

~~~
WorldWideWayne
I'm mildly annoyed at the absurdity of people writing TL;DR after typing out
three whole sentences.

In case people don't know - another way to start your last sentence is: In
summary...

~~~
CPLX
Thank you. This phenomenon is, in my opinion, among the most annoying things
the internet has ever produced.

------
qwerty85344324i
Serious question for anyone opposes this. What incentive would pharma
companies have to publish their secret formulas if Indian generics simply take
the IP and drastically undercut prices, preventing the pharma companies from
making any profit on the billions they invested in their research? What would
compel these pharma companies to invest in any further research?

~~~
drabiega
I'm not sure why you need to get hypothetical here. Clearly, they currently
have sufficient incentive since they're currently investing in research. They
are trying to get a likely small amount of additional money (the people in
India who could actually afford their prices) in return for an immense cost
human cost.(The people who would lose access because of their prices) Why
would anyone not oppose this?

~~~
saint_fiasco
>Clearly, they currently have sufficient incentive since they're currently
investing in research

Drug research takes a long time. The drugs that cause this debate are drugs
that the pharmaceutical companies decided to research decades ago, when they
seriously expected people would respect intellectual property rights more than
human lives.

Now that they know better, they will probably go invent a new Viagra or
something instead of inventing something useful which can be prematurely
generified for the common good.

~~~
meric
And that's okay. I'll take millions of Indian lives _now_ than thousands of
American's and hundreds of Indians in ten years - when a new drug that can
save some lives potentially comes onto the market, a new drug not many people
can afford.

~~~
saint_fiasco
I'm not sure where you are getting those numbers. It's very difficult to
calculate the costs in human lives of all the drugs that won't be invented in
the future.

Lots of people are already dying of antibiotic resistant bacteria, for
example, and that's a problem likely to get worse over time.

~~~
meric
The average Indian cannot afford to take a 1USD per tablet drug once a day. So
if that's how all the new drugs are going to be priced - significantly higher
than generics, then I say India should go ahead and make generic versions of
those drugs, even if it will in future break international law. Who are you to
say they should sacrifice their lives so you can have access to better drugs
10 years later that they can't afford anyway?

~~~
saint_fiasco
India can make generic versions of old drugs. For people who can't afford 1USD
a day, having access to bleeding edge medicine isn't going to make as much of
a difference as having access to nurses and penicillin. edit: and sanitation,
and health education, and so on.

EDIT: Not to mention having their own research and development. I bet it's
cheaper to research stuff in India, but evil selfish pharma companies don't
want to invest in research in countries with poor intellectual properties
protection.

~~~
meric
Did you know if a pharma company takes an old drug and a new chemical to it to
change its effects slightly, the patent is renewed, and that way it it never
actually becomes 'old' enough? India will go on and ignore these patents to
make generic drugs. Millions of indians have access to affordable medicine
today. We can worry about the future benefits when you successfully petition
oil companies to stop drilling for oil and invest in renewables instead. The
Indian pharmaceutical industry is vibrant and thriving, that is why it has the
capacity to reproduce generic versions of patented drugs at will.

You can live a perfectly fine, if frugal, life in India on USD $2 a day, but
not if you have to pay for USD $1 tablets.

~~~
saint_fiasco
>The Indian pharmaceutical industry is vibrant and thriving, that is why it
has the capacity to reproduce generic versions of patented drugs at will.

I thought any lab could do that. Isn't the research part the most difficult
and expensive part?

>if a pharma company takes an old drug and a new chemical to it to change its
effects slightly, the patent is renewed, and that way it it never actually
becomes 'old' enough

I've heard about this happening with 'me-too' drugs and bullshit
antidepressants. Does it happen as well with essential life saving medicine?

~~~
meric
_I thought any lab could do that. Isn 't the research part the most difficult
and expensive part?_

"The Pharmaceutical industry in India is the world's third-largest in terms of
volume and stands 14th in terms of value."

"Indian companies carved a niche in both the Indian and world markets with
their expertise in reverse-engineering new processes for manufacturing drugs
at low costs."[2]

There is skill involved in reverse-engineering new processes for manufacturing
drugs.

 _Does it happen with essential life saving medicine?_

Yes.

"...Glivec, a medicine for chronic myeloid leukemia"[1]

"The Supreme Court defended India’s right to deny patents to incremental
improvements. It ruled that Glivec was merely a new form of an older drug and
did not constitute a patentable invention. “This is a huge relief,” said Unni
Karunakara, the president of Médecins Sans Frontières, which cares for
patients in poor countries. Novartis is less pleased, declaring that the
ruling “discourages future innovation in India."

Did you previously think pharmaceutical companies care about people's lives
more than profit? I'm sorry to disappoint.

[1]
[http://webcache.googleusercontent.com/search?client=safari&r...](http://webcache.googleusercontent.com/search?client=safari&rls=en&q=cache:tzV31BJwCoQJ:http://www.economist.com/blogs/schumpeter/2013/04/drug-
patents%2Bindia+pharma+renew+patent&oe=UTF-8&gfe_rd=cr&hl=en&ct=clnk&gws_rd=cr)

[2]
[https://en.wikipedia.org/wiki/Pharmaceutical_industry_in_Ind...](https://en.wikipedia.org/wiki/Pharmaceutical_industry_in_India)

------
werber
There should be a global consortium for socialized medicine. It's insanely
problematic to have for profit companies demanding the right to kill the poor.

------
Alex3917
This is hardly new. The Clintons threatened to impose trade sanctions on South
Africa if they distributed HIV treatments to the poor, and that was twenty
years ago.

~~~
rev_bird
"The Clintons"? We're going to lump Hillary in with the policies of an
administration that she _married into_?

~~~
Alex3917
It's a healthcare issue and she was head of healthcare reform.

------
creamyhorror
Look how Novartis and other drug companies are pricing their cancer drugs:

[https://www.change.org/p/secretary-of-health-and-human-
servi...](https://www.change.org/p/secretary-of-health-and-human-services-
protest-high-cancer-drug-prices-so-all-patients-with-cancer-have-access-to-
affordable-drugs-to-save-their-lives)

 _Prices have increased more than tenfold between 2000 (average price
$5,000-$10,000 per year) and today (average price of new cancer drugs exceeds
$120,000 per year)._

[http://www.nytimes.com/2015/01/15/opinion/why-drugs-cost-
so-...](http://www.nytimes.com/2015/01/15/opinion/why-drugs-cost-so-
much.html?_r=0)

 _Novartis, the company that makes the leukemia drug Gleevec, keeps raising
the drug’s price, even though the drug has already delivered billions in
profit to the company. In 2001 Novartis charged $4,540, in 2014 dollars, for a
month of treatment; now it charges $8,488. In its pricing, Novartis is just
keeping up with other companies as they charge more and more for their drugs.
They know we can’t say no._

[http://www.nbcnews.com/health/cancer/utterly-broken-drug-
mar...](http://www.nbcnews.com/health/cancer/utterly-broken-drug-market-high-
cost-surviving-cancer-n369261)

 _Lauren Baumann is one of the lucky ones. Though she has cancer, chronic
myeloid leukemia, it is manageable, as long as she takes a daily pill called
Gleevec. Gleevec is considered a wonder drug, turning Lauren 's leukemia from
a death sentence to a disease she and thousands of others can live with. The
problem is, even with health insurance and a full-time job, Lauren can't
afford the monthly co-pay for Gleevec. It can be as high as $2,000 a month —
twice the average mortgage payment in the U.S.

"I feel like you get punished," says Baumann. "I didn't ask to get cancer; I
didn't ask to get sick. I was 26 and I was perfectly healthy."_

This is essentially extortion due to price inelasticity of demand.
$9,000-$12,500/month to survive, for the rest of your natural life!
Patients+insurers have to pay whatever price the companies ask. For something
as crucial as a life-saving drug, maybe the prices shouldn't be set only by
market forces? Maybe generics should be allowed for import after patents
expire the first time around?

(There are analyses of drug discovery costs around, and even after all those
costs and reliance on basic research funded by taxpayer money, pharma
companies make a very healthy profit. Much of the money goes into marketing,
which we wouldn't need so much of in a system similar to the NHS which
approves drugs for dispensing countrywide.)

Please sign the above Change.org petition (first link) and spread it! I
normally don't make appeals, but this is one truly egregious case of unethical
profiting.

An international panel of 115 doctors co-authored a paper decrying these
ridiculous prices and offering 7 solutions, including allowing Medicare to
negotiate drug prices once again (which they now aren't allowed to!):

[http://www.forbes.com/sites/matthewherper/2015/07/23/155-ang...](http://www.forbes.com/sites/matthewherper/2015/07/23/155-angry-
doctors-propose-7-solutions-for-terrifying-cancer-drug-prices/)

~~~
ultramancool
> maybe the prices shouldn't be set only by market forces??

It's (arguably) not the market here that's the problem, but the patent. The
patent means that generic manufacturers can't get in on the market and create
a commodity out of it with a race to the bottom on price. The problem isn't
the market, but the absolute lack of a market created by the exclusivity of a
patent.

We need to find a way as a society that these companies can profit off the
research and development of these drugs while still allowing generic
manufacturers to do what they do best: create a real, competitive market to
produce the drug in bulk.

Unfortunately I don't think there's any clear answers here.

~~~
brianwawok
Government funding the research + selling the drugs at cost would benefit
mankind overall... but then politicians would decide how many $ to spend
researching which drug per year, which has it's own downsides..

~~~
ekianjo
> Government funding the research + selling the drugs at cost would benefit
> mankind overall...

Wasnt that how NASA was supposed to work ? Oh wait, we know how it went...

~~~
RodericDay
We went to the moon?

~~~
ekianjo
I'm talking about what happened to NASA after that. Obviously look at the
ridiculous budgets they have now.

------
petecooper
>India under pressure from Pharma lobby to stop gneric medicines

Title typo: should be `generic`.

------
theworstshill
US Pharmaceutical companies don't give a damn about their own compatriots, so
why wouldn't they try to monopolize the world?

Back in 2010-2011, a few friends of mine showed me how an online pharmacy
works, I couldn't believe it - vast majority of people ordering Indian
generics are Americans. The reasons? - Costs. Theyve told me it sometimes
takes multiple resends of medicines for them to get through the border. Don't
know how well US clamped down on it in the past several years.

------
raphinou
I heard a country in europe stopped drugs import from india on quality
concerns. Is that true? Is that the real reason or is there more behind that
decision?

~~~
DanBC
There's a recent trade deal where concerns about data led to ban on 700 meds.

[http://www.ft.com/cms/s/0/4ded8ca4-3b8a-11e5-bbd1-b37bc06f59...](http://www.ft.com/cms/s/0/4ded8ca4-3b8a-11e5-bbd1-b37bc06f590c.html#axzz3jquJ67jM)

That follows similar concerns in the US.

[http://mobile.nytimes.com/2014/02/15/world/asia/medicines-
ma...](http://mobile.nytimes.com/2014/02/15/world/asia/medicines-made-in-
india-set-off-safety-worries.html?referrer=&_r=0)

[http://mobile.reuters.com/article/idUSBREA2H06Y20140318](http://mobile.reuters.com/article/idUSBREA2H06Y20140318)

(I've given up guessing what a clean URL should be. Now I'm just going to post
whatever stupid URL a site gives me.)

------
PhantomGremlin
Maybe the Indian generic companies should worry a little more about the frogs
and flies in their manufacturing facilities. And maybe they shouldn't delete
test results.

Welcome to the global race to the bottom. I doubt that a little pressure from
multinational pharma companies will do much to reverse the overall trend.

[http://www.bloomberg.com/news/articles/2014-12-03/indian-
lab...](http://www.bloomberg.com/news/articles/2014-12-03/indian-labs-deleted-
drug-test-results-documents-show)

~~~
forgetsusername
> _I doubt that a little pressure from multinational pharma companies will do
> much to reverse the overall trend._

Good. An imperfect (with the odd frog), but cheap, system that can save
thousands of lives is perfectly acceptable to me.

~~~
StavrosK
Really? I'd rather die than eat some fly poop that found its way to my life-
saving medication!

~~~
garagemc2
Than do that, but don't stop others. Have your originals, let those that need
it have their generics. Just because you shop at waitrose doesn't give you the
right to stop people shopping at Aldi!

~~~
saint_fiasco
StavrosK is being sarcastic. That's why he specified 'life-saving medication'.

~~~
StavrosK
Thank you, you nailed it.

~~~
garagemc2
My bad. Sorry.

~~~
StavrosK
No problem, you can never tell with Poe's law.

