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Brazil successfully hardballs Abbott on AIDs drug

Byoliveridley

I mentioned in May that Brazil had introduced compulsory licensing on a Merck AIDs drug Efavirenz, and heartily recommended that Brazil and other third world countries continue to play hardball with big pharma whenever they could. It looks like Merck decided to not bargain, but Abbott did on Kaletra. Note that Abbott got into a similar controversy with Thailand, and agreed to drop the price when Thailand rejected the Kaletra patent.

Keep it coming, third world countries. Bargaining is perfectly acceptable in the marketplace!

Brazil says Abbott to cut price of AIDS drug | Health | Reuters

razil’s health ministry said Wednesday that Abbott Laboratories Inc. agreed to cut the price of its Kaletra AIDS drug by 29.5 percent.

The lower price for the drug, also known as lopinavir and ritonavir, will help Brazil supply free drugs for its AIDS treatment program.

In May, President Luiz Inacio Lula da Silva authorized Brazil for the first time to break the patent on an AIDS drug, one made by Merck & Co.. It then started importing a generic version of the drug Efavirenz from India.

Under WTO rules, countries can issue a “compulsory license” to manufacture or buy generic versions of patented drugs deemed critical to public health.

Drug makers often reduce prices to keep countries as clients and avoid compulsory licenses.

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    Black Lung – Miners pay so you can get more coal

    Byoliveridley

    The Pump Handle alerts us to a special report on coal miners and their lungs, not for the faint of heart, but something to keep in mind when you hear the phrases “Cheap Energy” and “coal” in one sentence, it’s not so cheap for these people.

    Black Lung: Dust Hasn’t Settled on Deadly Disease « The Pump Handle

    Louisville-Courier Journal reporters Laura Unger and Ralph Dunlop offer us the voices and faces of miners who are suffering from coal workers’ pneumoconiosis. Their special report, Black Lung: Dust Hasn’t Settled on Deadly Disease, includes an on-line version which features five compelling videos featuring 40- and 50-year old coal miners who are now suffering with the disabling lung disease. Mr. Danny Hall, 56, for example, who is still severely impaired despite receiving a lung transplant says “if I had to do over, I wouldn’t ever go into coal mining.”

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    Circumspection on Circumcision – Lessons for India

    Byoliveridley

    Circumcision May Help Protect Against HIV – washingtonpost.com

    Getting circumcised may reduce men’s risk of acquiring HIV, according to a study conducted in Africa. “Our study shows that circumcised men had 53 percent fewer HIV infections than uncircumcised men,” lead study author Robert Bailey, professor of epidemiology at the University of Illinois at Chicago (UIC), said in a prepared statement.

    This study, published in The Lancet (registration and kidney donation required!) adds to the growing body of research suggesting that circumcision significantly reduces the incidence of HIV infection. The doubts on circumcision as a protective factor against HIV are falling away.

    But, is this a viable public health strategy? In context, the US health and human services reports an 85% reduction in HIV risk through condom usage. This is probably a conservative estimate. There’s no indication yet that the gains from circumcision and condom use together are multiplicative.

    Let’s look at India, for instance. Circumcision is not practiced among Hindus. There is no history of circumcision, and when I was growing up, it was clear that circumcision was for Muslims and Muslims only. It was often laughed about and there was a sense of superiority about not having to mutilate. It was a clear distinction setting difference between “us” and “them”. This article by Jaishanker and Haldar provides some perspective on Hindu-Muslim identities.

    Apart from that, the other important identity of Muslim males is circumcision. It is found in many riots that Muslims were victimized based on their religious identity. In the riots if the perpetrators or the police are not able to identify victims with their religion they forcefully remove the pants of the victims to check whether they are circumcised or not. Once they find that the victim is circumcised he is targeted without further analysing which community he belongs to.

    For example in Bombay riot (1992) there is a case of man who was frisked by the police for assessing whether he was a Muslim. However, out of fear he gave his name as Raju (a Hindu name) the officer made him take out his trousers and, noticed that he was a circumcised Muslim, and fired at him.

    No Hindu parent in their right mind would circumcise their male child. It’s that simple. It’s part of the ingrained Hindu psyche that having an uncut member sets us apart from our Muslim brethren.

    Nothing has changed about AIDS prevention strategies. But it’s boring to study the same variables all the time, let’s recap them one more time, shall we!

    Education and awareness: Look at this picture from India (from the NFHS Survey):
    Now tell me that increasing awareness among women and empowering them is not the most important thing you can do!

    Condom use = 85% risk reduction

    Nothing more to say. Continuing to improve access to condoms is important. Avert indicates that condom use is very state dependent, especially among sex workers, with Tamil Nadu having an 80-90% use rate and Mysore in neighboring Karnataka having a 9% use rate.

    Access to antiviral therapy

    India is in a lucky position here with a very well established pharmaceutical industry. So, drugs are likely to be available (patent issues notwithstanding). The issue however is with infrastructure, getting the drugs to the right people at the right time. This 2004 paper from the Indian Journal of Medical Ethics indicates that coverage is spotty at best. India’s National AIDs Control Organization (NACO) recognizes this, but in my opinion does not go far enough to provide free/affordable drugs to infected people, especially to prevent mother-child transmission.

    So, to cut a long story short, circumcision in India is not likely to be a factor in the pantheon of choices available. We have a long way to go with our other major AIDS prevention challenges, and I hope this circumcision issue does not become an increasing distraction.

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    Men – An Endangered Species due to Endocrine Disruptors.

    Byoliveridley

    Why, it’s a girl, how surprising!!

    Man-made chemicals blamed as many more girls than boys are born in Arctic | The Guardian | Guardian Unlimited

    Twice as many girls as boys are being born in some Arctic villages because of high levels of man-made chemicals in the blood of pregnant women, according to scientists from the Arctic Monitoring and Assessment Programme (Amap).
    The scientists, who say the findings could explain the recent excess of girl babies across much of the northern hemisphere, are widening their investigation across the most acutely affected communities in Russia, Greenland and Canada to try to discover the size of the imbalance in Inuit communities of the far north.

    In the communities of Greenland and eastern Russia monitored so far, the ratio was found to be two girls to one boy. In one village in Greenland only girls have been born.

    Why are the upper latitudes especially vulnerable? Two reasons, firstly, atmospheric currents carry pollutants from the Mid-Latitudes (i.e the US, China and Europe) to the higher latitudes of the Arctic. Secondly, the pollutants they measured, PCBs, are persistent and stable (which is why they were used in the first place) and accumulate in the fat tissue of animals. So, predator fish on top of the food chain (the large oily ones) tend to accumulate a lot of these compounds. When you live in the Arctic, you tend to eat a lot of fish. So, these people are getting slammed.

    I tell you, Children of Men is not as far fetched as it sounds! Though I think the high levels these people accumulated in their system may not be representative of the rest of the world (vegetarian diets, for instance would be lower in persistent pollutants unless you consumed a ton of milk products), it is still a very scary story.

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    Gaping Reminders of Aging and Crumbling Pipes – New York Times

    Byoliveridley

    Gaping Reminders of Aging and Crumbling Pipes – New York Times

    Local and state officials across the country say thousands of miles of century-old underground water and sewer lines are springing leaks, eroding and — in extreme cases — causing the ground above them to collapse. Though there is no master tally of sinkholes, there is consensus among civil engineers and water experts that things are getting worse.

    The Environmental Protection Agency has projected that unless cities invest more to repair and replace their water and sewer systems, nearly half of the water system pipes in the United States will be in poor, very poor or “life elapsed” status by 2020.

    Yes, sewers are unsexy, there’s no new fancy science involved. But water and sewer systems are the very basis of public health, and the biggest reason why Americans don’t die of sleeping sickness and dengue fever (or their subtropical equivalents) in large numbers evey year. People who want to cut taxes and limit government need to keep this in mind. There’s no money to be made out of building and maintaining sewers, it’s a dirty job and government has to do it, or else nobody will, and money is required. We produce the waste, we need to be taxed appropriately for it. It’s that simple.

  • Melamine movin' on up the food chain

    Byoliveridley

    The FDA mentioned recently that the melamine suspected of poisoning many cats had gotten into pig feed in California, well, it gets worse…

    Tuesday: Uh-Oh — North Carolina Public Radio WUNC

    The FDA announced this afternoon that thousands of hogs in NC and four or five other states are now under quarantine because they were fed tainted rice gluten. Hogs here and in CA have tested positive for melamine. No one knows yet whether it poses any dangers to humans who ate the hogs, but the feds say they’re trying to find out.

    At this point in time, I would consider any animal feed from China suspect. Way out of control, because we have no procedure for being proactive about these things…

    It won’t amount to much because melamine apparently does not affect humans as much as it seems to affect cats, but it is the utter lack of control of ingredients and raw materials that scares me. What else can sneak through? What if the next one is actually deadly to humans?

  • Doctors Take Bribes to Prescribe Drugs

    Byoliveridley

    This is the headline I would have used on this story. An incentive scheme to use a paticular product in a situation like this is a bribe.

    Doctors Reap Millions for Anemia Drugs – New York Times

    Two of the world’s largest drug companies are paying hundreds of millions of dollars to doctors every year in return for giving their patients anemia medicines, which regulators now say may be unsafe at commonly used doses.

    The payments are legal, but very few people outside of the doctors who receive them are aware of their size. Critics, including prominent cancer and kidney doctors, say the payments give physicians an incentive to prescribe the medicines at levels that might increase patients’ risks of heart attacks or strokes.

    Industry analysts estimate that such payments — to cancer doctors and the other big users of the drugs, kidney dialysis centers — total hundreds of millions of dollars a year and are an important source of profit for doctors and the centers. The payments have risen over the last several years, as the makers of the drugs, Amgen and Johnson & Johnson, compete for market share and try to expand the overall business.

    So how does this kickback scheme work?

    Federal laws bar drug companies from paying doctors to prescribe medicines that are given in pill form and purchased by patients from pharmacies. But companies can rebate part of the price that doctors pay for drugs, like the anemia medicines, which they dispense in their offices as part of treatment. The anemia drugs are injected or given intravenously in physicians’ offices or dialysis centers. Doctors receive the rebates after they buy the drugs from the companies. But they also receive reimbursement from Medicare or private insurers for the drugs, often at a markup over the doctors’ purchase price.

    Medicare has changed its payment structure since 2003 to reduce the markup, but private insurers still often pay more. Combined with those insurance reimbursements, the rebates enable many doctors to profit substantially on the medicines they buy and then give to patients.

    The rebates are related to the amount of drugs that doctors buy, and physicians that agree to use one company’s drugs exclusively typically receive higher rebates.

    Wow, that’s a scheme that would be illegal in almost any situation. I buy 10 widgets from the manufacturer for $100. The manufacturer then gives me $50 in “rebate”. I charge the person on whose behalf I am buying these widgets $200 even though I am not supposed to make a profit on this transaction, and pocket $150 from a transaction. I also promise to use more of this widget, on people who may or may not need it, but on whom I have such a knowledge gap and power gap that I know that they will use it whether it is actually good for them or not. I also promise not to use a competitor product even though I know that there are cases where one product will be better than the other. Well, who pays, all of us in increased health insurance premiums and healthcare costs so a bunch of rich doctors can drive their Range Rovers around.

    The USA is no different from India when it comes to schemes like this. The money involved is greater, and somehow, this is not called a bribe by the media.

    What does the pharma spokesperson have to say?

    Johnson & Johnson said yesterday in a statement that its rebates were not intended to induce doctors to use more medicine. Instead, the rebates “reflect intense competition” in the market for the drugs, the company said.

    Amgen said that rebates were a normal commercial practice and that it had always properly promoted its drugs.

    Yes, it’s competitive out there, and to ensure that our product gets used, we will bribe people.

    The “consumer” is the person who pays for the product or service. The “consumer” here is the end user, the patient. The patient does not get the rebate, instead having to pay high prices so doctors can add to their six figure incomes. Nice!