IPN Health Blog

Ukraine government provoking rise in fake medicines?

The Ukraine government has hyped up the threat of swine flu, causing panic-driven demand for medicines, claims an intriguing blog post on UkraineWatch.

According to the piece, the government subsequently:

• Caused stock-outs through scaremongering, as demand skyrocketed
• Imposed price controls
• Threatened to arrest anyone "profiteering" from the swine flu panic

As a result of the latter two policies, supply of medicines plummeted. So having boosted demand, they then quashed supply.

Smart, eh?

The article says this caused people to turn to traditional remedies (boosting their prices, too), yet an equally likely side-effect would be an increase in fake medicines.

And this month we've already had news of high levels of fakes in Ukraine - such as in this excellent report on SecuringPharma.

Reliable figures, they state, are not readily available to reveal how many fakes operate in the Ukraine market. But with neighbouring Russia's leading industry in fake Tamiflu, I bet there's a steady supply plaguing the market.

If this is the case, hopefully people will remember the policymakers who kicked it off in the first place.

Salt and Shake Spin

“UK experts” warn that the government target for cutting the salt you put on a baked potato isn’t strict enough.

That’s according to the BBC, whose coverage gives the impression the only dispute among our benign dietary overlords is between whether they should terrify us into near total salt avoidance, or just plain scare us into a slightly less tasty diet.

But there’s plenty of evidence that the whole statist plan to regulate the nation’s scrambled eggs needs to be taken with, well, a pinch of salt. When new anti-salt ads were unveiled in October, The Times quoted Catherine Collins, chief dietician at St George’s Hospital in London: “Advice to cut back on salt really is the poorest of all the dietary messages around.”

So who are the “experts” recommending that the government’s action against pork scratchings must go futher? As so often in these cases, fakecharities.org can help. Here we find that "Consensus Action on Salt and Health" receives substantial donations from the Food Standards Agency, the government agency it is supposedly lobbying for more regulation. Somehow the BBC fails to mention this.

Perhaps we need  a new study into whether state-funded charities and state-funded news websites might just have a bias towards deeper state involvement in our choice of crisps.

Marc Sidwell

Innovation versus Rationing

The latest headline-filling case of NHS rationing emerges today, with news that another new cancer drug will be unavailable to patients in the United Kingdom.

This time it's Nexavar, which can extend life for up to 6 months for people with liver cancer.

The announcement comes just weeks after the last of a long string of studies to show up the UK's quite abysmal cancer survival rates.  The UK's largely government-owned, -funded and -run health service constantly falls behind other systems which utilise private providers and offer a greater variety of choice.

Meanwhile, on a more optimistic note, the Cato Institute have released an interesting paper on Why America Leads the World in Medical Innovation.  Definitely worth a peruse.

Unless, of course, your cancer is being 'treated' by the UK's state monopoly, in which case such innovative drugs will be considered "not cost effective" enough to keep you breathing.

Seizures confusion drags on

If there's one thing we don't need in the fight against fake drugs, it's more confusion and misinformation. Yet the issue of the day--the EU's seizures of Indian medicines in transit--is being warped by mix-ups over the most basic of facts.

An article in the Business Standard today claims rather sensationally that:

"All the consignments detained so far have eventually been found to be of genuine, off-patent generic drugs on their way to countries where these are not patented."

And therefore, they argue, "there is no evidence" that seizures are defending patients against counterfeit drugs or even genuine intellectual property rights violations.

All the consignments, they say? All medicine consignments seized by EU authorities?

This seems in direct contradiction to EU Taxation and Customs documents, the last of which (published in July 2009) reported that there were 3,207 seizures in 2008, 93 per cent of which were on suspected trademark breaches.  Only a minority (6 per cent) were for patent infringement.

EU seizures of medicines increased by 57 per cent on the previous year (2007) following the launch of the MEDI-FAKE action.

This drive saw over 34 million illegal pills seized. The EU details cases of mass seizures of counterfeit medicines, such as 600,000 counterfeit antimalarials that were seized in Brussels (presumably on their way to Africa).

We know that fake medicines are entering and passing through European countries. Even in the UK authorities have reported increased amounts of counterfeit medicines being imported in recent months.

If this crucial context is ignored, and the facts obfuscated, there will never be a solution delivering free trade rights and access to high quality medicines.

Fake Russian tamiflu comes as little surprise

As fears over swine flu peaked in the summer, search engine queries for "Tamiflu" soared by 1,400 per cent according to a report from software security firm Sophos.  The correlation is not hugely surprising, nor is the news that fake Tamiflu, thriving on this sudden internet-based interest, is being produced and transported from Russia.

In June 2008 the Russian Federation Council held a meeting entitled "The role of the state in the protection of the Russian market from counterfeit medicine."  A more honest meeting would have evaluated the role of the state in flooding the market with counterfeits in the first place.

Corruption and a complete disregard for the rule of law have been at the root of Russia's counterfeiting and 'grey market' pharmaceutical trades (for more info, see Making a Killing, page 21).

A company named Bryntsalov A produce up to 10 per cent of pharmaceuticals in Russia, yet this year they were found guilty of counterfeiting over 50 brands of medicine.  Remarkably, as reported on the excellent SecurePharmaChain blog, the punishment was little more than a "slap on the wrist", with token fines dished out of no more than $1,500.  By pure coincidence, two leading figures in the company are siblings Vladimir Bryntsalov and Tatyana Bryntsalova, the former being an ex-candidate for President (yes, of Russia). Both are said to have extremely strong political links.

It is therefore little wonder that only one victim company, Pfizer, had begun taking legal action according to the article (at IPN we've stressed the importance of civil law in deterring counterfeiters - in many countries, the rule of law is so weak, and political corruption so great that civil proceedings are simply not viable). In 2006 Pfizer surveyed the fakes market in Russia, finding an unusually high standard of counterfeit drug production (which is not, of course, to say that the drugs are good). All indicators point towards a very professional class of counterfeiters, in league with the political elite.

For these reasons, one must be extremely cynical when leading political figures (including Medvedev and Putin) pledge to "protect" their people from counterfeit drugs.  Rather than looking for political saviours we should be looking for political culprits, and ensuring they're accountable for their crimes.

Trading Away Access to Medicines?

Coinciding with another controversial seizure of medicines in the EU (Paris, this time) a group of NGOs have released a joint statement criticising EU trade policy.  Oxfam, HAI, and MSF have attacked the European Commission for its support of intellectual property (IP), which they claim “benefits…IP holders at the expense of Access to Medicines for millions of people, particularly in poor countries.”

The document is essentially an anti-IP polemic, in which the signatories rail against the alleged “deficiencies” of the patent system of “leaving a research gap” and neglecting diseases. We have argued against these claims in the past but they’re tangential to the enormous health threat that everyone else (Time magazine, Jacques Chirac, the WHO, UN head Ban Ki-moon, the Gates Foundation…) is talking about—the danger of drug resistant diseases, induced by counterfeit drugs.  Rather than conflating many issues and ideologically opposing all IP, health activists should take a more practical view on how IP laws can be shaped to help poor people in less developed countries (LDCs).

Access to medicines is an insufficient goal in global health. We should be aiming for access to high quality medicines. Substandard drugs (especially counterfeits) cause more harm than good, injuring patients and burdening poor countries and healthcare resources with new waves of drug-resistant disease.

When counterfeiters fake a product, they often fake a trademark too—it’s part of their deception, to leech off the good reputation of others. Stopping these fakes is one of the simplest means of protecting the poor from bad medicines and should be acceptable to opponents of other forms of IP. Even MEP Christian Engström of the Pirate Party agrees, stating last week: “The primary function of trademarks is to act as consumer protection ... The Pirate Party has no objections in principle to combating counterfeit goods or upholding the existing trademark laws.”

EU seizures of pharmaceutical goods in 2008 were almost entirely (93 per cent) for trademark infringement—ie. on suspicion of being fakes. Only 6 per cent were for patent infringement. By focusing on a minority of cases (for patent-infringement), groups like Oxfam, HAI and MSF are ignoring the main threat to patients in LDCs; and by conflating the issues and seemingly opposing all IP, they risk damaging measures that safeguard the poor from fake drugs.

Perhaps I’ve missed statements from these groups regarding the seizures of fake drugs (rather than generics), but given the severity of the situation they should be making more noise and making clear their views. Do they really think medicines with fake trademarks should be released into poor country markets? One hopes not. It’s time we stopped obfuscating this issue with squabbles over other areas of IP and found consensus in the fight against fakes.

UN confirms bed-nets not slept under, used for fishing

The UN continues to boast of millions of dollars of public money being spent on bed-nets, this time on a project in Tanzania costing $111 million.

However, the inefficiency of such schemes is infamous. Some factors are now confirmed by Ray Chambers, the UN's special envoy for malaria, who admits that people often use the nets "to catch fish".

He also confirms that "one out of two people will not sleep under a net". This blog has previously noted how people find nets uncomfortable, or simply not much use when their living conditions are particularly poor. Furthermore, they often need to be retreated with insecticides every few months.

It is no myth that they are often sold on to make fishing nets or wedding dresses.

Amusingly this story comes just days after the news that a team of peacekeepers avoided malaria entirely by - shock horror - killing as many mosquitoes as possible. The team used housefly killing machines to protect them from mosquitoes, and remarkably the infection rate plummeted all the way down to zero.

Presumably it's too late to reinvest that $111,000,000.

Mosquitoes to carry insecticides

The innovation of getting mosquitoes to carry insecticides to their own larvae is proving hugely effective, according to an article in magazine SciDev.

Researchers spread an insecticide among adult mosquitoes who then transported it back to their breeding sites.

The results were startling:

Placing the insecticide in just 3 - 5 per cent of resting areas resulted in 95 - 100 per cent of larvae dying in aquatic breeding sites.

The development offers great hope in the ongoing battles against vector-borne diseases such as dengue and malaria, especially given the stifled markets for new insecticides.

Defending the indefensible

The Indian government is to launch a campaign in South Africa this week, desgined to "counter the multinational companies' (MNCs) propaganda against Indian generic drugs in African countries."

But what "propaganda" is this?

The report states: "generic drugs are not counterfeit drugs as is being spread by the MNCs."

Of course generic drugs are not necessarily counterfeits, but vast amounts of seized drugs coming from India are counterfeits.

Last week the EU released new data showing that yet again most fake drugs are coming from India.

Over half the medicines stopped at EU borders for intellectual property infringements were from India.

The most high-profile examples of these seizures have been those committed in the Netherlands over alleged patent infringements. Certain groups have cried incessantly about the injustice of these seizures, accusing the EU of endangering lives.

Yet these seizures are in the minority - only 6% of seizures in 2008 were for patent infringement, while 93% were for trademark infringements.

And another word for a faked trademark is "counterfeit."

Packaging with fake trademarks will likely contain fake drugs. People receiving these fakes can have no confidence in the medicines they're taking, and it is their lives that are being endangered far more than any the EU is supposedly responsible for.

Let's hope delegates in South Africa bear that in mind more than propaganda from any side.

The Gates Foundation: help or hindrance?

I'm on the BBC World Service today discussing the Gates Foundation, and whether or not it is skewing efforts to improve global health. 

Check it out here: http://www.bbc.co.uk/iplayer/console/p0038yg4