Great News, but Innovative, Really?

Byoliveridley

The “innovation” in this approach is not scientific, but economic.

Cheap drugs for poor nations | Guardian Weekly | Guardian Unlimited

Improvements they devise to the molecular structure of an existing, expensive drug turn it technically into a new medicine that is no longer under a 20-year patent to a multinational drug company and can be made and sold cheaply. The process has the potential to undermine the monopoly of the big drug companies and bring cheaper drugs not only to poor countries but back to the UK.

Okay, I may be missing something here, but this is not a scientifically innovative strategy. They are called Me-Too drugs. Pharma has been doing this for years. Read this article in the Stanford Medicine Magazine about exactly how this is done.

Nexium illustrates the drug makers’ strategy. Many chemicals come in two versions, each a mirror image of the other: an L-isomer and an R-isomer. (The “L” is for left, the “R” is for right.) Nexium’s predecessor Prilosec is a mixture of both isomers. When Prilosec’s patent expired in 2001, the drug maker was ready with Nexium, which contains only the L-isomer.

Is Nexium better? So far,

there’s no convincing evidence that it is, says Stanford drug industry watcher Randall Stafford, MD, PhD.

This is a well known and well used strategy. The Government Accounting Office (GAO) recently released a study which concluded that 68% of all drugs developed in the US between 1993 and 2004 were Me-Toos.

So, what is “innovative” and “revolutionary” about this approach is that non-profits are driving the drug development. By outsourcing the entire clinical trial to India, substantial savings are to be had. By not having to fund the US shareholders’ need for huge profits, enormous company overhead, high salaries, multi million dollar executive bonuses and marketing expenses that US/European pharma require, cost savings are potentially huge.

The downside? Well, unless the studies are run according to US/EU GLP/GMP guidelines, data quality, and therefore, drug safety can be suspect. The pedigree of the people involved in this effort makes it unlikely that the data is going to be suspect. If their ultimate aim is to sell these drugs in England, then they will have to meet the most stringent standards available.

Of course, these drugs will never hit the US of A. I can already hear the fear mongering, the safety doubts being raised, the “terrorists may get their hands on your pill” bogey, etc. But, Americans can afford to pay for their drugs more than your average Indian suffering from Hepatitis C can. Once the already teetering (by first world standards, of course!) healthcare system in the US gets closer to collapse (by first world standards, of course!), some of these “innovations” will become more viable in this most reactionary of countries.

I hope this model is proven to be viable.

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    India, The Emerging (polio stricken?) Tiger

    Byoliveridley

    States on alert against polio – NDTV.com – News on States on alert against polio

    India appears to be in a grip of a polio outbreak with 352 cases reported so far this year, many of them from areas that were free of the virus, and officials fear the number may increase further. Uttar Pradesh alone has reported 312 cases, the highest of all the states, and World Health Organisation officials have described it as an “exporter” of the disease.

    In Uttar Pradesh, officials said 90 percent of the cases were due to ignorance in the minority Muslim community, who believed the polio vaccine could make children impotent.

    From wikipedia

    Only four countries in the world (Nigeria, India, Pakistan, and Afghanistan) are reported to have endemic polio.

    I remember reading about a Nigerian Province issue with Clerics claiming “that vaccines supplied by Western donors were adulterated to reduce fertility and spread AIDS as part of a general war on Islam”, which the Wikipedia Polio article verifies. But we have never seen this in India before, and I find it hard to believe. I will remain sceptical about the Muslim clerical influence on India’s polio debacle unless I hear better. News from India sometimes builds its own “truth momentum”, with speculation and hearsay morphing into bulletproof truth in a matter of hours. It is also easy in India to start rumors to deflect blame.Here’s a contrarian take from a Reuter’s Article

    “Tens of thousands of children were missed by state health workers over the past year during rounds of immunization, leading to a resurgence of the virus, they said.

    “We are very concerned. It raises the threat to India and is also threatening other countries,” said Jay Wenger, head of the National Polio Surveillance Project, a collaboration between the WHO and the Indian government.

    One federal official said around 10 percent of children in several western districts of Uttar Pradesh, known for its ramshackle state health care and sluggish bureaucracy, could have missed immunization between late 2005 and early 2006.

    “These (vaccination) rounds were of poor quality,” said the official, who did not want to be named.”

    Well, sounds more logical, does it not? But why let the depressing truth of inadequacy get in the way of a juicy and self-perpetuating tale of Muslim backwardness.

    India, the emerging tiger.

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    India at 60 – A Public Health Perspective

    Byoliveridley

    Well, at least I don’t have to take part in endless parades and listen to speeches any more. But India turned 60 today, and the head of the Indian public health foundation takes stock, and it is sobering.

    The Hindu : Persisting public health challenges

    Recent health indicators in India are a cause for both celebration and concern. While life expectancy at birth has risen to 63 years, infant mortality rate (IMR) and maternal mortality rate (MMR) are still at unacceptably high levels (57 per 1000 and 301 per 100,000 live births respectively). There is widespread disparity among States with Kerala being the star performer. Within States, the rural areas are way behind the urban segments. Even as our economy has grown rapidly, the nutritional status of children has remained stunted, suggesting that wide income disparities are preventing the poor from becoming the beneficiaries of growth.

    Yes, I be the killjoy.

    More from Amartya Sen

    There is reason enough to celebrate many things happening in India right now. But there are failures as well, which need urgent attention. For example, there is still widespread undernourishment in general and child undernutrition in particular–at a shocking level. The failures include, quite notably, the astonishing neglect of elementary education in India, with a quarter of the population–and indeed half the women–still illiterate.

    The average life expectancy in India is still low (below 64) and infant mortality very high (58 per 1,000 live births). It is certainly true that India has narrowed the shortfall behind China in these areas–that is, in life expectancy and infant mortality–but there is still some distance to go for the country as a whole. The problems are gigantic in some of the more “backward” states like Bihar and Uttar Pradesh. And yet there are other states in which the Indian numbers are similar to China’s.

    he goes on…

    If India has to overcome these failures, it has to spend much more money on expanding the social infrastructure, particularly school education and basic health care. It also needs to spend much more in building up a larger physical infrastructure, including more roads, more power supplies and more water. In some of these, the private sector can help. But a lot more has to be spent on public services themselves, in addition to improving the system of delivery of these services, with more attention paid to incentives and disciplines, and better cooperation with the unions, consumer groups and other involved parties.

    Ah, basic and boring infrastructure building!

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    Mercury Exposure in India?

    Byoliveridley

    Ex-workers ask HLL to accept liability for mercury deaths

    The death of a 47-year-old man who had worked for a Hindustan Lever thermometer factory for 18 years brought out hundreds of ex-employees, who had also been exposed to toxic mercury, to the streets.

    Scores of people in the area suffer from skin diseases, premature greying, incessant headaches, stomach pain, kidney problems and blood in the urine, say the former workers who approached the Supreme Court in 2005 demanding compensation.

    Well, I don’t know what to say. This tragedy goes on in India continuously, occupational pollution exposure is through the roof in most factories. Safety equipment is not used, enforcement is minimal, all in all, in a country of 1+ billion people, some are more expendable than others.

    I suspect this one is getting more play because a large multinational is involved. But Indian factories are equal opportunity killers, whether owned by large behemoths like Unilever, or by your local rotary club small businessman.

    It looks like they have not even done an autopsy/blood test to look for mercury in this man’s system, so it’s early days.

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    Colonialism: Environmental Edition

    Byoliveridley

    Does put recycling in context…

    Independent Online Edition > Environment

    Regardless of how carefully you separate your waste, there is a good chance a disposal firm will dump it all in together with other kinds of plastic trash and ship it to the developing world to be dealt with by a family of migrant workers earning a pittance. They will deal with the salad-bar container, the pistachio ice-cream container and the superfluous bag for carrots in your shopping basket in a variety of different ways – it may be recycled, it may become landfill or it may simply be burnt. Whatever happens, it is generally not a priority for the waste disposal company. Britain dumps around two million tonnes of waste in China every year, everything from plastic mineral water bottles to shopping bags and other forms of superfluous packaging from some of the country’s biggest supermarkets.

    Same for India as well. The article says that all of this “recycling” is illegal. But how do you hide 200,000 tonnes of plastic waste?

    Read the whole article, it is tragic. Some highlights:

    So too are the many and varied health complaints suffered by the local population, who risk multiple skin ailments and exposure to potent carcinogens as they touch the contaminated materials. Poisonous chemical effluents stream into their water supply, turning it black or lurid red, and studies by Greenpeace show that acid rain is the norm in this region. Children are prone to fevers and coughs. Their skin is often disfigured by the toxic plastic waste they have to process.

    A report by the University of Shantou on the town of Guiyu, another Guangdong recycling hub, showed that more than 80 per cent of local children suffer from lead poisoning.

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    Monsoon no longer determines India's economic fate?

    Byoliveridley

    The Indian Express has a rather giddy article about monsoons and the economy. It was an article of faith growing up that if/when the monsoon failed on a particular year, the country’s economy would suffer greatly. Apparently, this is not true any more.

    Monsoon grip on India’s economy weakens

    The early arrival of India’s annual monsoon promises good crops and incomes for millions of farmers but economists say the rains no longer hold such a sway over Asia’s third-largest economy as they used to in the past.

    It is true that agricultural now contributes to 22% of the economy as opposed to 38% in 1980. But, this kind of economic cheerleading is foolish. As the article itself admits, 700 million people live off farming related activities. India’s irrigation infrastructure is poor. The crop growing cycles are based primarily on the monsoon rains, their timing, the rain volumes during certain months, etc. You really think that an event that adversely affects 700 million people won’t devastate large swathes of the country?

    Economists place way too emphasis on single macro variables. The relevant variable here is 700 milion!

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    Sunita Narain on the Tata Nano

    Byoliveridley

    nano.jpg Unless you have been living under a rock recently (hey, nice way to start a blog post, insult your reader(s)), you must have heard of the Tata Nano, the much ballyhooed cheapest car ever built. People ask me (after all, I am Indian and pretend to know a lot about the environment) what I think of the Nano. Well, it’s hard to summarize in an elevator pitch. Obviously, given the state of public transportation in the cities, people want private vehicles to travel in, more convenient, fewer people to jostle against, etc. People previously riding scooters and motorcycles (and carrying entire families in a two wheeler) would prefer this car. But, traffic’s going to get worse, and cars occupy a lot of road space while not carrying that many people.

    Anyway, my thoughts aside, Sunita Narain (one of India’s most famous environmental activists) and director of  The Center for Science and Environment (India’s most active Environmental NGO) writes one of her typically insightful editorials in Down to Earth, the CSE’s flagship publication.

    Let’s take the ‘affordability’ question first. The fact is that cars—small or big—are heavily subsidized. The problem is that when economists (including those who run the government) fret and fume about mounting subsidy bills, they think of farmers—fertilizer, electricity and food—not our cars. But subsidy is what they unquestionably get.The subsidy begins with the manufacture of cars. When we read about the Singur farmers’ struggle to stop government from acquiring their land for the Tata car factory we don’t join the dots. We don’t see this as the first big subsidy to motorization. The fact is, in Singur the manufacturer got cheap land, interest-free capital and perhaps other concessions—the Left Front government in West Bengal never made public full details of its attractive package. This brought down the cost of production and allowed the manufacturer to price the Nano at Rs 1 lakh

    The Nano-flyover syndrome | Editor’s Page | Down To Earth magazine

    All very true. Cars are heavily subsidized, taxation, parking, you name it, money quote…

    Since cars take up over 75 per cent of the road space, even though they move less than 20 per cent of the people, it is obvious whom this expenditure benefits the most.

    Yes, cars are not a very efficient way to move people, they’re convenient because Indian cities are not being planned to prioritize public transport that is convenient, safe and clean. India’s  per capita income (nominal) is about a $1000 per year and the nano, even in its cheapest form, is about 3 years worth of the average income. So, your average Indian, even if she lives in a city and makes twice this average, will not buy this car. So, she’s stuck on the bus which crawls ever so slowly due to all these nanos flitting about. Or, she’s on a scooter/bike facing ever increasing pollution due to these cars and risking life and limb as traffic pushes vehicles closer and closer together.

    But of course, this seems to be the pattern of development and optimists will argue that at some point in time, the infrastructure will catch up to the point that there will be room for all these cars and money for all the people to buy all these cars. But as Ms. Narain points out, 20% of Delhi is already covered with roads (hard to get that number in context though, I have no idea what percent of NYC is road covered, for instance!), so finding room to build more roads is going to be hard.

    Something’s gotta give, I don’t know what!

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