7 ms·

India’s Efforts to Aid Poor Worry Drug Makers

33 points by vellum 13y ago

girvo 13y ago
I'm sort of conflicted. I feel that the profits that the pharmaceutical companies receive from first world developed countries coupled with the strong IP protection they enjoy here should be good enough, and I'm happy those in other countries receive the care they need. But then, China, India, they have a lot of very rich people too, so to pull it off in a way that to a first approximation makes sense, means some odd regulation and making it harder for people to get it in general without going through hoops. I don't know... Drugs are such a weird thing to think about: we're talking about peoples lives here, and as far as I'm concerned human life is the most important thing in the world, and profiteering from that in the way that pharma companies do sometimes (ever greening, and the like) is unethical in my opinion, the research that they conduct creates a lot of value. Truly, I don't know the correct way of thinking about pharmaceutical companies and business. Hard topic.
- nazgulnarsil 13y ago
  I don't think it's just to lump pharm behaviors under profiteering. Certainly some goes on, but that they can charge a high price is the reason some of these revolutionary medicines were developed in the first place. If R&D doesn't pay itself back, companies won't do it, and humanity is the poorer for it. Any sort of two tiered approach encourages people to cheat the system. I agree it's a tough problem, and we probably haven't found the optimal balance.
  - ericd 13y ago
    Perhaps we could step up government funded drug research, and the government could license it to every drug company? We all benefit from curing these chronic diseases, and the current model isn't exactly a model of efficiency.
    - rational_indian 13y ago
      government = corrupt body = money sink
      - ericd 13y ago
        To clarify, I was saying that the US govt. should play a bigger role in drug R&D, not the Indian govt (though maybe they should too). US government research money largely goes to research scientists at universities in the form of research grants, so it's not really the government performing the research and spending the money. I wouldn't say the university research departments are money corrupt money sinks. They could also license the fruits of the research to drug companies in other countries for a nominal fee (or free) as a form of humanitarian aid.
        rational_indian 13y ago
        I guess you can safely ignore my comment then :)
  - yodsanklai 13y ago
    "If R&D doesn't pay itself back, companies won't do it, and humanity is the poorer for it." There's also the option of public research.
  - girvo 13y ago
    See, yeah, I totally get that. But, these are peoples lives were talking about, and considering marketing is 20x what is spent on R&D... The system we have is the best we've got, I'll admit. I can't think of a better way personally, but that still sucks IMO :(
    - gaius 13y ago
      I see where you're coming from, but there are lots of things you could put in that category: food, water, warm clothes, energy for heating and cooking, etc etc. Should no-one working in any of these industries be entitled to no more than minimum wage? I think most people would say no, and I think most people would agree that the profit motive has made all of these industries more efficient, e.g. there were and are famines in countries where farmers can't make a profit, but very few in the West.
  - betterunix 13y ago
    Why do companies have to pay for R&D? Other fields of science and medicine are paid for with grant money from the government. Let the government pay for pharma research and let a competitive market sell the products of that research without patents or other such nonsense.
- hingisundhorsa 13y ago
  I don't feel conflicted. Patent protection was established as a mechanism to encourage and facilitate innovation and to encourage inventers. The question I ask myself is whether the current system is sufficiently balanced. In my opinion, it is not. It is way too much in the favour of large pharma. A good way to check that it is, would be to examine the books of a pharma company and check what percentage of profit (not earnings) goes to R&D versus other areas like say marketing. This journal article suggests that marketing spending is 20 times higher than that on R&D. [1] http://www.bmj.com/content/345/bmj.e4348 http://www.bmj.com/content/345/bmj.e4348 That causes me to be skeptical of pharmaceutical company claims that the generics industry is killing innovation. I've even heard a pharma marketeer use the term "Indian generics terrorism" which is exceedingly callous given that we're basically choosing to deny life to those individuals who can't afford big pharma marketed drugs. The patent system was not intended to be used to justify such behavior.
  - grandinj 13y ago
    Why should they be spending all their profits on R&D and not marketing? Do you refuse to wear name-brand clothes because they spend 90% of their profits on marketing? I just don't get the R&D vs Marketing hate.
    - hingisundhorsa 13y ago
      Marketing was the example in the article. It is also one that catches my attention because I was aware of a case where my personal physician was pushing a particular drug and I was aware that pharma salesmen (marketeers) are permitted to encourage physicians to favor their products through controversial freebies like free trips to company seminars in the Bahamas, etc. I have no hate for marketing. If I had found a article contrasting how much is spent on legal versus R&D, I would have used that. And, by chance, yes, I do refuse to waste an extra dime on clothing just for a logo.
      - grandinj 13y ago
        > yes, I do refuse to waste an extra dime on clothing just for a logo. But I notice that you don't pass moral judgment on them for doing so. We need to separate the (strong, IMO) argument against bad marketing, from the (weak, IMO) argument against the proportion of R&D vs Marketing spend.
gaius 13y ago
India has nukes, aircraft carriers and a space programme. It is not a poor country. It has poor people tho' because... It has nukes, aircraft carriers and a space programme. Priorities! EDIT I assume this is being downvoted because it doesn't kowtow to the "big pharma is EEEVIL" groupthink, but it doesn't make it any less true.
- ashray 13y ago
  It's not really that straightforward. Believe it or not, developing nukes, aircraft carriers, and a space programme is actually easier than lifting 600 million people and all their future generations out of poverty. Take the above into perspective. High tech research, industry, etc. also need huge investment. What happens if we educate tons of our population and then they end up without jobs ? (this actually happened in Soviet states not so long ago..) Reduction of poverty and advances in technology have to happen in tandem. Besides, most of the amazing strides the US made in technology have origins in military/space exploration applications. Reduction of poverty in India is definitely a priority. It's just one of the priorities. We have a $20 Billion educational plan coming into force soon (targets higher education as well as lower levels). Every problem in India is a problem of scale and penetration. I hope people on HN will appreciate that. Bill Gates certainly recently understood that when he decided to join the fight against polio.
  - gaius 13y ago
    That is also true, but it is a matter of perspective. I am writing this from the UK where we don't have aircraft carriers or indigenous launch capability anymore. There is a time for national prestige but there is also a time to be pragmatic about what a nation can actually afford.
    - ashray 13y ago
      It's not because of national prestige (except the space program). The UK doesn't have any of those things because they have big daddy USA protecting them if the need arises. India does not have anyone to protect her against China or Pakistan. In fact, China has been phenomenally increasing it's naval concentration in the Indian ocean. India has failed to grow an indigenous military industry (except for nukes and some other stuff..) and this has resulted in India becoming the largest purchaser of weapons worldwide. Definitely not a title I am proud of. Geopolitics is complex. It could be argued that had the US/UK not 'enabled' Pakistan back in the day we wouldn't have this problem today. It was good for western nations to have an ally in this region against Russia and thus Afghanistan during the cold war era. But I'd like to add. On the subject of our space program. Our president a few terms ago was a fisherman's son (and he was from a very poor family..) who eventually went on to become a rocket scientist and then later the president of the country. We are working on poverty, a one sided perspective on such a complex issue doesn't do it justice. We need the space program as much as we need to improve food distribution. And we have enough people to work on many problems simultaneously. I can understand that as someone from the UK you are upset because your government insists on giving aid to India. But the aid issue is politicized greatly. India has said several times that we do not want the aid but political forces in both countries have resulted in the continuation of aid. I can see how the UK media might spin that into 'Oh, we give them aid and they make missiles'. All I can say to that is, it's not true. I'd encourage anyone to research this more to arrive at the real facts. We don't make nukes with aid money.
ShirsenduK 13y ago
I am from a small Indian town. And the reality which I have seen first hand is; the subsidized medicines don't reach the poor and the doctors; who are bought by the big pharma companies; prescribe some variant which is not subsidized. The subsidized medicines are never in stock as they are sold in the black market. Its sad to see politics of corruption hampering research.
ashray 13y ago
I personally think that medicine IP should have some sort of limitation where discoveries in the pharma world cannot be profited from in perpetuity. Even generic drugs in the western world are VERY expensive. Most of them are simple compounds and the major justification of price is R&D. Maybe a better solution would be to have differential pricing for different regions ? Like, Kindle Books are cheaper in India. Well, of course, there is the question of the radically poor who live on less than $1 a day. They wouldn't be able to buy a Kindle Book any more than they can buy a strip of aspirin. However, there are so many levels of ethical implications involved in this kind of situation because we're talking about people's lives. Maybe another idea could be to have a 5 year IP advantage and then make the medicines 'public domain' ? IP laws are based on profit incentives but when dealing with something with such huge humanitarian ramifications we should definitely take the time to re-evaluate our position on it. Even people in the western world should have access to cheap medicines. What needs to be balanced is the innovation/profit incentive with the humanitarian aspect of it.
- rational_indian 13y ago
  Kindle Books are cheaper in India? This is news to me. How cheap are they exactly?
  - ashray 13y ago
    50-70% on average, here's an article I wrote about it a few months ago, you can buy them from Amazon India regardless of where you live and your billing details: http://bkpk.me/tip-save-big-on-your-kindle-books/ http://bkpk.me/tip-save-big-on-your-kindle-books/
    - flueedo 13y ago
      That's awesome! But one question, couldn't the kindle book editions differ across countries in some cases? Just as, as for example, physical editions may differ between America and the UK?
      - 13y ago
namlem 13y ago
I'm OK with this. The current system of drug development isn't sustainable anyway. The rate at which drugs are improving has slowed dramatically. We have picked all the low hanging fruit. While I believe personal genomics may very well usher in a golden age of drug development, we need some way of making testing the drugs easier and cheaper as well to fully reap the benefits.
zhaphod 13y ago
70% of people {think 800 million people} live on less than $2 per day in India. It would be naive to think that Indian govt will care about IP of Pharma companies. I understand it takes a billion dollar or more to create these block buster drugs, but a country like India cannot afford to worry about the profit these companies make. If these companies say they will either go out of business or stop producing these kinds of drugs it wouldn't matter to India. As a bulk of the people who need these drugs are already dying and a larger portion of the people will die. And India cant do a thing about it. That is the absurdity of the situation.
fatca 13y ago
Why would Indian people have to die of cancer, for the profits of the colluding US pharma oligarchy and their captive regulators? Both India and China are nuclear powers. Between them, half of the world population lives there. If I were India, I would not give in one single inch. Eventually, all respect is ultimately based on the fear for reprisals. Just as a matter of principle, I would rather press the nuclear button.
fit2rule 13y ago
The timing of this article - occurring right in the middle of TPP negotiations - is highly suspect .. Is this some sort of agitprop designed to make the disgusting provisions of the Trans-Pacific Partnership agreement (a truly vile development) somehow more palatable to the Western world? The TPP, if ratified by the Indian government, will give American and European Pharmaceutical companies near-complete control over the pricing of their drugs in the Asian theatre - which would be a most heinous development if it goes through, because it will undermine the sovereign rights of these governments to protect their people.
userbinator 13y ago
What a word-soup of a title. For some reason I parsed "worry drug" as a single noun and wondered why their makers are poor...
known 13y ago
Indian regime is spending $1 billion/year on space research when 50% of its children are malnourished. http://m.timesofindia.com/india/Every-second-Indian-child-is-malnourished-Report/articleshow/25724848.cms http://m.timesofindia.com/india/Every-second-Indian-child-is...

33 points by vellum 13y ago

girvo 13y ago

I'm sort of conflicted. I feel that the profits that the pharmaceutical companies receive from first world developed countries coupled with the strong IP protection they enjoy here should be good enough, and I'm happy those in other countries receive the care they need. But then, China, India, they have a lot of very rich people too, so to pull it off in a way that to a first approximation makes sense, means some odd regulation and making it harder for people to get it in general without going through hoops. I don't know... Drugs are such a weird thing to think about: we're talking about peoples lives here, and as far as I'm concerned human life is the most important thing in the world, and profiteering from that in the way that pharma companies do sometimes (ever greening, and the like) is unethical in my opinion, the research that they conduct creates a lot of value. Truly, I don't know the correct way of thinking about pharmaceutical companies and business. Hard topic.

nazgulnarsil 13y ago
I don't think it's just to lump pharm behaviors under profiteering. Certainly some goes on, but that they can charge a high price is the reason some of these revolutionary medicines were developed in the first place. If R&D doesn't pay itself back, companies won't do it, and humanity is the poorer for it. Any sort of two tiered approach encourages people to cheat the system. I agree it's a tough problem, and we probably haven't found the optimal balance.
- ericd 13y ago
  Perhaps we could step up government funded drug research, and the government could license it to every drug company? We all benefit from curing these chronic diseases, and the current model isn't exactly a model of efficiency.
  - rational_indian 13y ago
    government = corrupt body = money sink
    - ericd 13y ago
      To clarify, I was saying that the US govt. should play a bigger role in drug R&D, not the Indian govt (though maybe they should too). US government research money largely goes to research scientists at universities in the form of research grants, so it's not really the government performing the research and spending the money. I wouldn't say the university research departments are money corrupt money sinks. They could also license the fruits of the research to drug companies in other countries for a nominal fee (or free) as a form of humanitarian aid.
      - rational_indian 13y ago
        I guess you can safely ignore my comment then :)
- yodsanklai 13y ago
  "If R&D doesn't pay itself back, companies won't do it, and humanity is the poorer for it." There's also the option of public research.
- girvo 13y ago
  See, yeah, I totally get that. But, these are peoples lives were talking about, and considering marketing is 20x what is spent on R&D... The system we have is the best we've got, I'll admit. I can't think of a better way personally, but that still sucks IMO :(
  - gaius 13y ago
    I see where you're coming from, but there are lots of things you could put in that category: food, water, warm clothes, energy for heating and cooking, etc etc. Should no-one working in any of these industries be entitled to no more than minimum wage? I think most people would say no, and I think most people would agree that the profit motive has made all of these industries more efficient, e.g. there were and are famines in countries where farmers can't make a profit, but very few in the West.
- betterunix 13y ago
  Why do companies have to pay for R&D? Other fields of science and medicine are paid for with grant money from the government. Let the government pay for pharma research and let a competitive market sell the products of that research without patents or other such nonsense.
hingisundhorsa 13y ago
I don't feel conflicted. Patent protection was established as a mechanism to encourage and facilitate innovation and to encourage inventers. The question I ask myself is whether the current system is sufficiently balanced. In my opinion, it is not. It is way too much in the favour of large pharma. A good way to check that it is, would be to examine the books of a pharma company and check what percentage of profit (not earnings) goes to R&D versus other areas like say marketing. This journal article suggests that marketing spending is 20 times higher than that on R&D. [1] http://www.bmj.com/content/345/bmj.e4348 http://www.bmj.com/content/345/bmj.e4348 That causes me to be skeptical of pharmaceutical company claims that the generics industry is killing innovation. I've even heard a pharma marketeer use the term "Indian generics terrorism" which is exceedingly callous given that we're basically choosing to deny life to those individuals who can't afford big pharma marketed drugs. The patent system was not intended to be used to justify such behavior.
- grandinj 13y ago
  Why should they be spending all their profits on R&D and not marketing? Do you refuse to wear name-brand clothes because they spend 90% of their profits on marketing? I just don't get the R&D vs Marketing hate.
  - hingisundhorsa 13y ago
    Marketing was the example in the article. It is also one that catches my attention because I was aware of a case where my personal physician was pushing a particular drug and I was aware that pharma salesmen (marketeers) are permitted to encourage physicians to favor their products through controversial freebies like free trips to company seminars in the Bahamas, etc. I have no hate for marketing. If I had found a article contrasting how much is spent on legal versus R&D, I would have used that. And, by chance, yes, I do refuse to waste an extra dime on clothing just for a logo.
    - grandinj 13y ago
      > yes, I do refuse to waste an extra dime on clothing just for a logo. But I notice that you don't pass moral judgment on them for doing so. We need to separate the (strong, IMO) argument against bad marketing, from the (weak, IMO) argument against the proportion of R&D vs Marketing spend.

gaius 13y ago

India has nukes, aircraft carriers and a space programme. It is not a poor country. It has poor people tho' because... It has nukes, aircraft carriers and a space programme. Priorities! EDIT I assume this is being downvoted because it doesn't kowtow to the "big pharma is EEEVIL" groupthink, but it doesn't make it any less true.

ashray 13y ago
It's not really that straightforward. Believe it or not, developing nukes, aircraft carriers, and a space programme is actually easier than lifting 600 million people and all their future generations out of poverty. Take the above into perspective. High tech research, industry, etc. also need huge investment. What happens if we educate tons of our population and then they end up without jobs ? (this actually happened in Soviet states not so long ago..) Reduction of poverty and advances in technology have to happen in tandem. Besides, most of the amazing strides the US made in technology have origins in military/space exploration applications. Reduction of poverty in India is definitely a priority. It's just one of the priorities. We have a $20 Billion educational plan coming into force soon (targets higher education as well as lower levels). Every problem in India is a problem of scale and penetration. I hope people on HN will appreciate that. Bill Gates certainly recently understood that when he decided to join the fight against polio.
- gaius 13y ago
  That is also true, but it is a matter of perspective. I am writing this from the UK where we don't have aircraft carriers or indigenous launch capability anymore. There is a time for national prestige but there is also a time to be pragmatic about what a nation can actually afford.
  - ashray 13y ago
    It's not because of national prestige (except the space program). The UK doesn't have any of those things because they have big daddy USA protecting them if the need arises. India does not have anyone to protect her against China or Pakistan. In fact, China has been phenomenally increasing it's naval concentration in the Indian ocean. India has failed to grow an indigenous military industry (except for nukes and some other stuff..) and this has resulted in India becoming the largest purchaser of weapons worldwide. Definitely not a title I am proud of. Geopolitics is complex. It could be argued that had the US/UK not 'enabled' Pakistan back in the day we wouldn't have this problem today. It was good for western nations to have an ally in this region against Russia and thus Afghanistan during the cold war era. But I'd like to add. On the subject of our space program. Our president a few terms ago was a fisherman's son (and he was from a very poor family..) who eventually went on to become a rocket scientist and then later the president of the country. We are working on poverty, a one sided perspective on such a complex issue doesn't do it justice. We need the space program as much as we need to improve food distribution. And we have enough people to work on many problems simultaneously. I can understand that as someone from the UK you are upset because your government insists on giving aid to India. But the aid issue is politicized greatly. India has said several times that we do not want the aid but political forces in both countries have resulted in the continuation of aid. I can see how the UK media might spin that into 'Oh, we give them aid and they make missiles'. All I can say to that is, it's not true. I'd encourage anyone to research this more to arrive at the real facts. We don't make nukes with aid money.

ShirsenduK 13y ago

I am from a small Indian town. And the reality which I have seen first hand is; the subsidized medicines don't reach the poor and the doctors; who are bought by the big pharma companies; prescribe some variant which is not subsidized. The subsidized medicines are never in stock as they are sold in the black market. Its sad to see politics of corruption hampering research.

ashray 13y ago

I personally think that medicine IP should have some sort of limitation where discoveries in the pharma world cannot be profited from in perpetuity. Even generic drugs in the western world are VERY expensive. Most of them are simple compounds and the major justification of price is R&D. Maybe a better solution would be to have differential pricing for different regions ? Like, Kindle Books are cheaper in India. Well, of course, there is the question of the radically poor who live on less than $1 a day. They wouldn't be able to buy a Kindle Book any more than they can buy a strip of aspirin. However, there are so many levels of ethical implications involved in this kind of situation because we're talking about people's lives. Maybe another idea could be to have a 5 year IP advantage and then make the medicines 'public domain' ? IP laws are based on profit incentives but when dealing with something with such huge humanitarian ramifications we should definitely take the time to re-evaluate our position on it. Even people in the western world should have access to cheap medicines. What needs to be balanced is the innovation/profit incentive with the humanitarian aspect of it.

rational_indian 13y ago
Kindle Books are cheaper in India? This is news to me. How cheap are they exactly?
- ashray 13y ago
  50-70% on average, here's an article I wrote about it a few months ago, you can buy them from Amazon India regardless of where you live and your billing details: http://bkpk.me/tip-save-big-on-your-kindle-books/ http://bkpk.me/tip-save-big-on-your-kindle-books/
  - flueedo 13y ago
    That's awesome! But one question, couldn't the kindle book editions differ across countries in some cases? Just as, as for example, physical editions may differ between America and the UK?
    - 13y ago

namlem 13y ago

I'm OK with this. The current system of drug development isn't sustainable anyway. The rate at which drugs are improving has slowed dramatically. We have picked all the low hanging fruit. While I believe personal genomics may very well usher in a golden age of drug development, we need some way of making testing the drugs easier and cheaper as well to fully reap the benefits.

zhaphod 13y ago

70% of people {think 800 million people} live on less than $2 per day in India. It would be naive to think that Indian govt will care about IP of Pharma companies. I understand it takes a billion dollar or more to create these block buster drugs, but a country like India cannot afford to worry about the profit these companies make. If these companies say they will either go out of business or stop producing these kinds of drugs it wouldn't matter to India. As a bulk of the people who need these drugs are already dying and a larger portion of the people will die. And India cant do a thing about it. That is the absurdity of the situation.

fatca 13y ago

Why would Indian people have to die of cancer, for the profits of the colluding US pharma oligarchy and their captive regulators? Both India and China are nuclear powers. Between them, half of the world population lives there. If I were India, I would not give in one single inch. Eventually, all respect is ultimately based on the fear for reprisals. Just as a matter of principle, I would rather press the nuclear button.

fit2rule 13y ago

The timing of this article - occurring right in the middle of TPP negotiations - is highly suspect .. Is this some sort of agitprop designed to make the disgusting provisions of the Trans-Pacific Partnership agreement (a truly vile development) somehow more palatable to the Western world? The TPP, if ratified by the Indian government, will give American and European Pharmaceutical companies near-complete control over the pricing of their drugs in the Asian theatre - which would be a most heinous development if it goes through, because it will undermine the sovereign rights of these governments to protect their people.

userbinator 13y ago

What a word-soup of a title. For some reason I parsed "worry drug" as a single noun and wondered why their makers are poor...

known 13y ago

Indian regime is spending $1 billion/year on space research when 50% of its children are malnourished. http://m.timesofindia.com/india/Every-second-Indian-child-is-malnourished-Report/articleshow/25724848.cms http://m.timesofindia.com/india/Every-second-Indian-child-is...