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Medicine is probably the second best place after military where we can observe how greed and corruption are literally killing people. I'm living in Russia and
by googamooga 10y ago
Medicine is probably the second best place after military where we can observe how greed and corruption are literally killing people.
I'm living in Russia and recently have been involved in medical devices market here. The local market for cardiology stents (little springs they insert non-surgically into your heart to remove artery clogging and prevent heart attack or stroke) has been long occupied by the three US companies. The Russian company I invested in, made their own stent design and launched a production factory in Western Siberia. Our prices are three to four times lower that prices for the same class of stents from the US competitors and the quality is the same or higher. We fought out 15% or the market for the last two years.
I have to say, that almost 99% of all stents in Russia are installed at the cost of the state medical insurance - every person in Russia is covered by this insurance, and that insurance is just sponsored by the state or local budget. The budget allocated to this kind of medical support is fixed, so if the yearly budget is 100M rubles (our local currency) and cost of a manipulation and a stent is 100K rubles then you can install stents in 1000 patients in one year. If the price goes down four-fold, then it will be 4000 patients. And this stent manipulation is a life saver in true sense of this word. So, basically with our stents we can save four times more people's lives, which on a scale of Russia would be tens of thousands of people.
Here enters the greed and corruption. One of the US companies approached one of the most powerful Russian oligarchs with good ties in the government. He lobbied a government decree stating that this US company will be single supplier for cardiology stents starting Jan, 2017. So, all hospitals and clinics are obliged to buy stents only from them, at the price they set. Tens of thousands of Russian people will die each year because of the greed and corruption - and we can't do much about it.
- spraak 10y ago:( Thanks for sharing, I hope that something can change
- aikah 10y agoThanks, a perfect example demonstrating how corruption kills.
- jkot 10y agoSimilar in Czech republic. We buy equipment which is 3x more expensive than market value. Nobody cares because it is paid from public money.
- saiya-jin 10y agoname and shame please. the least we can do is, even if indirectly, vote with our money (since those companies make tons of devices & medications, and there is always some competition)
- Mandatum 10y agoVictor Vekselberg is the individual that made this happen, he's very close with the PM. He's also the head of the Renova Group who are Russian government backed who had the power to choose the supplier. Originally the plan was to develop this in-house.. Didn't turn out too well. Medtronic is the US company (Ireland HQ of course..) partnered with them. Sources (conveniently removed, Google cache version): http://webcache.googleusercontent.com/search?q=cache:YVnPx9aaAdYJ:sevendaynews.com/2016/06/01/global-manufacturer-of-medical-devices-has-become-a-partner-of-vekselberg/ http://webcache.googleusercontent.com/search?q=cache:YVnPx9a... Victor's relationship with PM: http://uk.reuters.com/article/uk-russia-vekselberg-pm-idUKKCN11Q288 http://uk.reuters.com/article/uk-russia-vekselberg-pm-idUKKC...
- googamooga 10y agoYes, originally they (Vekselberg/Medtronic) wanted to get $200M loan from a Russian state bank (VEB) to launch the production in Russia, but due to all the mess we have now instead of economy here in Russia VEB went into almost bankrupt state and their plans have never realised. Though single-source decree is still active and will be enforced on Jan 1st, 2017.
- metafunctor 10y agoWhich company, which oligarch? Can you reveal more details, proof, anything? Perhaps the easiest way we can do something about this is make some noise. But we need indisputable facts in order to do that. Edit: If you do decide to blow the whistle, please try to stay anonymous as best you can.
- googamooga 10y agoWell, everything is public information, so I see no harm in sharing the names: Russian company: Angioline (http://www.angioline.ru http://www.angioline.ru, the site is Russian-only) US company: Medtronic (http://www.medtronic.com http://www.medtronic.com) Oligarch: Victor Vekselberg (https://en.wikipedia.org/wiki/Viktor_Vekselberg https://en.wikipedia.org/wiki/Viktor_Vekselberg) Joint-venture created by Vekselberg and Medtronic for "technology transfer": http://stentex.ru/en/about/company_news/199 http://stentex.ru/en/about/company_news/199 Ties in the government: http://www.renova.ru/en/press-center/releases/21/1995/ http://www.renova.ru/en/press-center/releases/21/1995/ Single-source decree of the government: https://rg.ru/2015/05/14/stent-site-dok.html https://rg.ru/2015/05/14/stent-site-dok.html (sorry, I can't find English version) Don't be fooled by the press releases above - no actual transfer or localisation has been done or planned in the nearest future, they are just moving stents from Medtronic to Russia.
- danieltillett 10y agoAnyone a shareholder in Medtronics want to show up at their next annual meeting and ask them about this?
- adrianN 10y agoSounds like an excellent deal for the shareholders of Medtronics.
- fauigerzigerk 10y agoI'm not so sure about that. There is something called the Foreign Corrupt Practices Act (FCPA): https://www.sec.gov/spotlight/fcpa/fcpa-cases.shtml https://www.sec.gov/spotlight/fcpa/fcpa-cases.shtml
- hueving 10y ago>So, basically with our stents we can save four times more people's lives, which on a scale of Russia would be tens of thousands of people. So am I correct in understanding that the Russian healthcare system lets tens of thousands of people die every year because they can't get stents?
- googamooga 10y agoIn fact, you're right.
- erichocean 10y ago> because they can't get stents? Why can't a patient just buy a stent from your company (vs. asking the govt. to pay for it) and ask their doctor to "install" it? Is that illegal? (I have no idea how the Russian healthcare system works whatsoever.)
- smcl 10y agoIt'd be pretty rare for patients to start investigating the costs of each individual element involved in their treatment wouldn't it?
- erichocean 10y agoHe says they literally can't get a stent at all, because the government's budget for the year is gone. If that happens, presumably a Dr. could say "well, you can buy one yourself, it's x $" or whatever. But maybe not, I'm not Russian and don't know what the rules are there.
- googamooga 10y agoIt just don't work this way in Russia. Clinics financed directly from the budget for this kind of operations, there is no option in bringing your stent and then get your compensation for it from the state. Of course you may pay for the operation by yourself and don't expect any compensation - but this option is not affordable for 90% of the population.
- jinpa_zangpo 10y agoThere's no evidence stents prolong life. The real corruption is that stent operations continue to be done in spite of doctors knowing this.
- googamooga 10y agoThey can't prolong life, but they can save life if applied in right time-window after the heart attack. Also they increase quality of life of the patients.
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- jsight 10y agoThat statement is misleading as stated. There is plenty of evidence that emergency stents due to a heart attack save lives, thus prolonging the life of the person that would have died otherwise. Non-emergency stents are a different question. It seems like there is an increasing body of evidence that they do not prolong life, just as you said.
- Herodotus38 10y agoI agree with your response to the poster above, but I'm glad he/she made that post because it is an important point that I didn't see anybody else make. I have no reason to doubt the OP's assertion of corruption in the Russian medicine market, as I have worked with several people who did research in the US and practiced medicine in Russia and have heard similar stories from them. However, the OP's assertion that more stents = more lives saved is not entirely true as you and the above poster point out. They are clearly well studied and known to save lives, reduce long term morbidity from heart failure, etc.. in the setting of STEMI (ST elevation myocardial infarction, in other words a big acute heart attack). However, a large number are placed for angina and many studies have shown that they may not make a difference. There are risks with the procedure of placing them, the issues of having to take blood thinning medications afterwards, and so on. I guess the reason I wanted to comment is to expand this discussion a little because more stents (as the OP wants) in Russia doesn't necessarily mean more lives saved, but it does mean more business for OP. I do not know if there is such a shortage of stents in Russia that emergent catheterization is avoided, if someone knows this to be the case please correct me. Also, I don't want to come off as implying that the OP is corrupt or only in it to make money. Medicine is complex and (at least in my current opinion) probably benefits from a business side seeking to maximize profits through innovation as long as it is countered with health care workers (and I guess federal oversight) scrutinizing things towards the patient's best health to act as a counterbalance.
- rayiner 10y agoGreed in the medical industry doesn't "kill people." There is a difference between not saving someone's life and taking it. That moral distinction undergirds our whole economy. Corruption is bad, no doubt. But the double standard applied to medical companies makes no sense. If not saving lives is the same as taking ones, then many of the things developed by Silicon Valley are morally abhorrent. How many lives could be saved if the billions of dollars flowing into Facebook, Twitter, Tindr, YouTube, Netflix, etc. were used to buy or develop medicine? I could save the life of a kid in Africa suffering from malaria, but instead I chose to purchase a new Apple Watch. If people actually applied your moral principle in a non-hypocritical way, we'd have almost nothing to talk about on HN.
- Retric 10y agoIf I was going to save your life, and someone physically stopped me. Then that person killed you. Which is a huge distinction from the SV example. Otherwise locking someone in a room and not feeding them would not count as murder.
- nmeofthestate 10y ago>Greed in the medical industry doesn't "kill people." Well, if you read the comment you're replying to you'll see that, in fact, it does.
- raisedbyninjas 10y agoKilling by neglect or direct action is a line that is grayed by the lights of effective altruism.
- mikeash 10y agoThere's a difference between not saving someone's life and bribing an official to stop someone else from saving lives. This is no different than if I got a law passed saying that nobody was allowed to sell or give food to you. When you starve to death, would you say you weren't killed?
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- GFischer 10y agoExactly the same thing happened here in Uruguay, with the exact same product (stents). A company named Nafferton, distributor of Boston Scientific, managed to drive all other companies out of the market via legislation: http://www.elobservador.com.uy/con-monopolio-stents-otros-fabricantes-se-iran-uruguay-n239789 http://www.elobservador.com.uy/con-monopolio-stents-otros-fa... A year ago, the Court of Appeals annulled that, and we now can have more that one supplier (not sure if that's in practice now) http://www.elpais.com.uy/informacion/gobierno-se-encamina-anular-monopolio.html http://www.elpais.com.uy/informacion/gobierno-se-encamina-an... Edit: Court of Appeals, not Supreme Court. Not sure if it reached the Supreme Court.
- clueless123 10y agoFor a "Me too" , Peru's health ministry (The previous government) did the same on several medications increasing some prices by 18x. Hopefully the just installed government will revert this scam.
- oconnor663 10y ago> Tens of thousands of Russian people will die each year because of the greed and corruption The "because of greed" way of phrasing these things seems like a weird place to stop to me. If a rock falls on your head and kills you, I think it's fair to say you died "because of a rock". That seems like the key difference between your situation and everyone else's, that explains why you _in particular_ just died. But it would be weird to say that you died "because of gravity" or "because of the frailty of man".
- RodericDay 10y agoincorrect blandishments about "human nature" being greedy or whatever do nothing to move the discussion forward. they're thought-terminating cliches.
- projektir 10y agoThe point is that humans are not dying due to bad luck, due to their own faults, due to lack of resources, or due to any other "acceptable" cause. They're very much dying because someone else is working to amass extra wealth at their expense.
- TeMPOraL 10y agoIt's pretty simple. Greed seems to be what motivated the act of corruption, which leads to people dying when they could be not dying. It's as if I was drunk-driving and drove you over. It would not be said that "the car killed" you, but that "a drunk driver" killed you.
- M_Grey 10y agoThe problem is compounded here in the US by decades of people being ideologically inclined to actually support their own destruction in that regard.
- d0mine 10y agoHere's another (less life-threatening) example: The Conspiracy Behind Your Glasses https://www.youtube.com/watch?v=h7H-_8UkmFU https://www.youtube.com/watch?v=h7H-_8UkmFU