Indian generics and AIDS | Hacker News Reader

Indian generics and AIDS

frontline.in

149 pointsrrrazdan47 comments

In many ways India, due to its population and the strength of its generic industry, is the key battlefield for global pharma in their war against cheaper generics. Which is why the Obama administration is trying to arm twist India into blocking generics:

https://www.doctorswithoutborders.org/press/release.cfm?id=7...

http://jonathanturley.org/2013/09/26/obama-to-india-block-pr...

India is also aggressively trying to reduce variation in drug prices within the country too.

"Consumers will be the biggest beneficiaries as prices of some brands may fall by up to 70 per cent. [...] Analysts estimate that the policy will cover two-thirds of the Rs. 60,000 crore domestic industry. [...] The new policy differs from the existing DPCO 1995 in that it is based on the simple average price (SAP) for all brands with a market share above 1 per cent in their segment. The new policy also uses a market-based pricing mechanism against the earlier proposed cost-plus method. [...] In the long-term, the policy proposes to reduce the bandwidth of prices of the same molecule and this will have an impact on manufacturers in the mid and lower segments, analysts feel."

http://www.thehindu.com/business/Industry/new-drug-price-reg...

I wish India were doing as well in controlling tuberculosis. Both a newspaper in the United States, which did much to break the story,[1] and a newspaper from India[2] are in agreement with official sources from both countries[3][4] that much more needs to be done to stop the spread of drug-resistant strains of tuberculosis in India, which could threaten the health of the whole world. (A century and a half ago, tuberculosis was perhaps the world's leading cause of death.)

[1] http://online.wsj.com/news/articles/SB1000142405270230344420...

[2] http://articles.economictimes.indiatimes.com/2013-06-23/news...

[3] http://www.iom.edu/Reports/2012/Facing-the-Reality-of-Drug-R...

[4] http://www.tbcindia.nic.in/pdfs/RNTCP%20Response%20DR%20TB%2...

Not directly relevant. Not required to add "ifs" and "buts" to each story.

I wonder if policy in India on generic drugs has some relevance to treatment of tuberculosis. In any event, there is a grave threat to world health from multiple-drug-resistant tuberculosis, and I hope they are correspondingly urgent efforts to deal with the problem in India, the center of this dangerous new infectious disease.

Cheap generics were very important in the fight against HIV / AIDS in Africa.

But there were other problems with HIV / AIDS treatment. Government ministers believing and promoting nonsense herbal "treatments" and attacking ARVs.

http://www.irinnews.org/report/93411/africa-the-crazy-things...

> "I am sure and I have evidence that someone who was [HIV] positive turned negative after prayers," she said. - Christine Ondoa, Uganda health minister

> Mbeki stirred controversy when he questioned the causal link between HIV and AIDS; in 2000 he set up a Presidential AIDS Advisory Panel, largely comprising AIDS denialists, to discuss how South Africa should deal with the crisis.

> Mbeki also evoked conspiracy theories by alleging that the US Central Intelligence Agency, working with large pharmaceutical companies, was part of a conspiracy to promote the view that HIV caused AIDS.

> According to the authors of a 2008 Harvard study, more than 330,000 lives were lost as a result of the delays in implementing a feasible and timely ARV treatment programme in South Africa.

> [Manto Tshabalala-Msimang, SA health minister 1999-2008] approach to HIV/AIDS drew widespread international condemnation, which came to a head following the 2006 International AIDS Conference in Toronto, when she insisted that garlic, lemon and beetroot be displayed in South Africa's exhibition booth.

Not having the brand name pills doesn't mean people campaign for those meds. It leaves a vacuum for ruthless, evil, people to exploit sufferers.

Mathias Rath (Vitamins cure AIDs, ARVs don't do anything except kill people) http://www.irinnews.org/report/83497/south-africa-final-chap...

> The drug, known as Virol ZAPPER, was being sold in 37ml liquid doses, each costing about US$210; patients were advised to take 10 drops daily. It was being advertised on local radio and TV stations as a miracle cure for HIV. http://www.irinnews.org/report/94679/africa-snake-oil-salesm...

Actually by and large Indian government has done a good job fighting diseases like Polio. They set up centers accessible to nearly every one, where you could have Polio drops administered to kids. Generally these are near places of worship, schools or community centers. The government also bought in celebrities to campaign for that.

I see the same for Tuberculosis, malnutrition, maternal health, child diarrhea and many other public health things.

But definitely more can be done.

Please note India also has massive corruption in private set ups. Pointless tests, surgeries,needless medication advices to inflate bills, treatments purpose fully stretched... etc etc. It all happens.

"Please note India also has massive corruption in private set ups. Pointless tests, surgeries,needless medication advices to inflate bills, treatments purpose fully stretched... etc etc. It all happens."

- It will always happen in any country - more so in poor countries like India. Even then its not so bad - you need to visit other countries to comment on a relative basis. This is way worse in a lot of other countries - including the US.

If we talk about the broader perspective, so much credit should go to the Indian Supreme court and its patent office for taking bold stance, time and again, on this broken patent system, allowing generics to make affordable ones.

For example: http://en.wikipedia.org/wiki/Novartis_v._Union_of_India_%26_... talks about how cancer drug were made affordable. Novartis (Switzerland) set the price of Gleevec at USD 2666 per patient per month (which is almost double of India's annual per-capita nominal GDP USD1414); Whereas, generic companies were selling their versions at USD 177 to 266 per patient per month. We can safely presume the situation to be much worse in Africa.

Based on this possibility, support is being replicated to Africa, notably for cancer, AIDS and TB.

Very sobering, and an inspiring stance against big pharma by India. I always had the impression (fuelled by big pharma propaganda?) that there was some debate around the effectiveness of generic ARVs, at least initially. Unfortunately, it sounds like there is much more that could have been done that wasn't until the Clinton Foundation's initiative.

> The history of the disease [is] well documented.

Eh. That's debatable, the history from the discovery (1980 onwards) is well-documented, the history before that... there are a pair of books (Pepin's The Origins of AIDS is the best I've found so far and an excellent read) but even then lots of the events are only circumstantially determined (e.g. hemo-caribbean's role in Haiti) and for others we only know the result (AFAIK we still have little idea how Robert Rayford contracted AIDS in Missouri in 1965~1966).

Here's what I don't get. After we liberalize drugs, abolish patents, and fill the world with generics- what do we do when private companies stop researching new drugs because the generics market will destroy ROI?

The same thing we are doing now. Research in universities, NSF labs and government funded programs around the world. Which are the major contributors to research around the world.

Print version - http://www.frontline.in/social-issues/indian-generics-and-ai...

WARNING - it will prompt you to print the article, so don't forget to cancel it.

For people who care, I support New incentives - an organization that's actively trying to help constrain AIDS in Africa and that has managed to do it in a very cost effective and transparent way.

Interesting

In many ways, and definitely in more ways than one, India is a fantastic resource, with their talent and tremendous headcount. India is definitely not a "pirate" state. I believe to have read that the Indian Navy is even involved in protecting merchant shipping lanes off the Somalia coast. The only qualms I have, is with the licence Raj, the paperwork kingdom, that ruins business opportunities all across India ...

> Indian Navy is even involved in protecting merchant shipping lanes off the Somalia coast.

Yes, it is true that Indian Navy/Coast Guard protects and also helpfully escorts maritime around that area [1].

It also protects the original untouched Sentinalese[2] tribes off the Andaman & Nicobar islands on the other side. Historically, our country has NEVER gone and attacked anyone in the past 3000 years. Sometimes because of our own resilience and other times because of our stupid prime minister.

[1] http://news.bbc.co.uk/2/hi/7736885.stm

[2] http://en.wikipedia.org/wiki/North_Sentinel_Island

> licence Raj, the paperwork kingdom, that ruins business opportunities all across India.

You're bang on this one. It's those 50-60 odd corrupt assholes on the top which make life hell for the rest of the population. Pretty similar to how things are here in the US, albeit the corruption part(?). Only magnified.

Invasions / raids have occurred in the past http://en.wikipedia.org/wiki/Chola_Navy

>>Pretty similar to how things are here in the US

Would like to know more about this. Are there same kind of bureaucratic hassles in US too?

I thought in some states like Delaware the taxes are too low and therefore makes sense to start up there. I've also heard similar things about Singapore.

I've never traveled outside India, and would love to know more about things in the US.

Companies are incorporated in Delaware because its corporate law and legal precedent are so well defined (and business friendly). Taxes aren't the sole concern, predictability is just as important.

> Would like to know more about this. Are there same kind of bureaucratic hassles in US too?

There is certainly bureaucracy in the US, but it would appear that it's worse in India:

http://doingbusiness.org/rankings

Maybe it's a joke I do not understand, but your country has been a battleground for years, kingdoms attacking other kingdoms for 1000s of year and more recently every so often Indian troops fire accross the line of control killing Pakistan soldiers (sure, Pakistan does it at least as much if not more).

> kingdoms attacking other kingdoms for 1000s of year

During that period in the history, the whole world was going through the same.

>more recently every so often Indian troops fire accross the line of control killing Pakistan soldiers

Pakistani army does it more often.

He didn't exclude the rest of the world. Also, he acknowledged the Pakistani side.

ohh, sorry, I missed the original comment which claimed the 3000 years thing. In that yes, yes, it's a ridiculous claim as India didn't exist before 1947.

>Also, he acknowledged the Pakistani side.

He said that India does it as much as Pakistan, which is false, and can be found by a simple google research. Pakistan is more guilty of violating ceasefires and attacking.

relevant links: http://en.wikipedia.org/wiki/2013_India%E2%80%93Pakistan_bor...

http://www.economist.com/blogs/banyan/2013/01/india-and-paki...

>>>> Maybe it's a joke I do not understand, but your country has been a battleground for years, kingdoms attacking other kingdoms for 1000s of year

If you're referring to historical ages, then this pretty much applies to all other continents including Asia, Europe, America etc. Wasn't it pretty common for kingdoms to wage wars against each other?

>>>> and more recently every so often Indian troops fire accross the line of control killing Pakistan soldiers (sure, Pakistan does it at least as much if not more)

It doesn't take much to Google to get your facts right. It's actually Pakistan that often violates cease-fire.

If you're referring to historical ages, then this pretty much applies to all other continents including Asia, Europe, America etc. Wasn't it pretty common for kingdoms to wage wars against each other?

The original poster said "3000 years", so I don't know why you'd get upset that someone started talking about history.

It doesn't take much to Google to get your facts right. It's actually Pakistan that often violates cease-fire.

We've always been at war with Eastasia

This is valid. Except for the joke part.

I love the downvotes for correcting some ridiculous nationalistic propaganda (that India has never attacked anyone in 3000 years). I guess that's what they are teaching in Indian schools today.

(Pre-colonial Indian history is currently a passion of mine.)

EDIT: and here come more downvotes.

You might have a point to make but it is your tone that is getting you the downvotes. If Pre-colonial Indian history is your passion, the least you can do is to think and analyze before making generic comments like "battleground" without adding any relevant context. Besides, you talked about the India/Pak border "firing" issues which is so complicated even for the citizens of those countries to understand that relating it to "attacking" in general is not fair.

If it's the tone, fine (kinda doubt it). But his reaction to propagandistic bullshit like that is understandable and justified.

You have my upvotes, Steve.

>>our country has NEVER gone and attacked anyone in the past 3000 years.

Well, our country didn't exist pre-1947, but we're arguing semantics now. Still, it's kindof bonkers to define the border of a fairly young "nation" over a period of 3000years. If you do that, then you need to consider the Mughal campaigns in Central Asia as they attacked Samarkhamd (Persia) as well as Kandahar (also persian held at the time). Or do you not consider them Indian?

OK then, consider that the Chola empire conquered sections of South East Asia. But perhaps you dismiss these conquests as exaggerations? (note that there is overwhelming evidence that atleast ports were raided even if there was no lasting presence -- it's still an "attack")

But if we are going to be pedantic, even post-Independence India declared war on Portugal and is considered the aggressor state when it "invaded" Goa: http://en.wikipedia.org/wiki/Invasion_of_Goa

Mmm, you're right w.r.t Goa and extricating out Bangladesh off Pakistan's. But there is much more prior to these controlled aggressions - for example "suspension of civil liberties" for those who lived under Portugese administration (see wikipedia). Let's also not forget that Goa was a colony of Portugal but originally it was a part of our land. Similarly sandwiching between Pakistan on left and Pakistan II on right wasn't a great experience either.

To get pedantic on this subject, even the Mughals aren't originally from India. Mughal campaigns in Central Asia was also about plundering and ruling India, it's not the other way round. In fact original Indians are not even Aryans (I am an Aryan) of European descendence for that matter. So my estimate of 3000 years stands corrected, it goes way further back than that.

Sentinals, for example in my prior comment, are aboriginal of the Indian peninsula. The other term used to represent aboriginal Hindus is the Dravidians. This land has chosen entropy over order, I can assure you.

It is specious to say that India has not invaded anyone in past 3000 years are so. The idea of India as a country is a fairly recent one. May be with some liberty we can consider 1857, year of Sepoy Mutiny as the starting point for idea of India as a single country. Prior to that the vast territory was divided among kingdoms battling against each other (Cholas against Chalukyas, Vijayanagar Empire against Bahamni Kingdom, Tippu against Marathas and so on).

The idea of India is not new. The idea that a country has to be politically united as a single country is new. If you read any significant Indian literature, you will notice there is a feeling of unity.

> It's those 50-60 odd corrupt assholes on the top ...

Are you saying that corruption exists only among this limited group of individuals?

> Historically, our country has NEVER gone and attacked anyone in the past 3000 years.

http://en.wikipedia.org/wiki/File:Rajendra_map_new.png

India is going to be (if not already) one of the largest consumers of Linux and other open source software.

I find it sad that most OSS conferences are held in Europe or USA, where you will find everyone toting Macbooks. Do note that I dont begrudge this and I do understand that it is the birthplace of most software.

However, I do wish that the chief developers reach out to the Indian community and help establish a vibrant ecosystem before we achieve Apple affordability.

India is easily one of the largest consumers of Linux. But consumer has a different meaning than contributor.

>>I find it sad that most OSS conferences are held in Europe or USA

Bangalore has its own version. Its called FOSS.in, there is also a Pycon. We also have regular conferences, meetups and hack nights. Checkout this Bangalore based company called HasGeek(https://hasgeek.com/)

The ecosystem is no where as mature as silicon valley, there is no where the kind of VC ecosystem like silicon valley. And YC like initiatives are non-existent.

And yet despite all this, nearly every one good I know has a namesake large company job while they are starting up on the side. There is massive start up interest and we are well past the days where people used to aspire for large company jobs. Though Ivy league degrees, and strong alumni connection gets you fat pay checks at big companies. People are beginning to match that with their own start ups.

Long way to go for us. But the opportunities are immense.

I am a frequent attendee at Hasgeek. However what I asked for was not about interesting conference but about decision making.

For example I wish that the top level decision making conferences (like UDS,etc) happen in India which is on track for being their largest consumers. This can only happen through the current decision making body.

I can assure you that is our concern too at HasGeek. It won't happen overnight but we will get there.

> I find it sad that most OSS conferences are held in Europe or USA, where you will find everyone toting Macbooks.

And how I weep, every time I see it.

The problem is that the macbook really is the best piece of laptop hardware on the market. The only other product that comes close in terms of build-quality and design is the Chromebook Pixel, and that one is a very niche device.

For a long time the laptop makers ceded the high-quality market to Apple and kept making cheap plastic crap. Even their high-end products were still plastic crap, just plastic crap containing better electronics.

After years and years, we're seeing makers like Asus and Dell take quality design seriously in their top end. But it's very late for that and Apple has a very strong hold on that market, and plus these companies sabotage their brand by making low-quality crap as well.

I mean, look at something like an HP Elitebook - a solidly built piece of hardware, but ugly as sin and plus every time HP tries to sell something high-end they're having to overcome the customer's bad memories of some horrible Pavilion.

Ah, ain't that the truth. I loved my HP Pavillion, until its motherboard glue melted and internal parts detached. Twice. Shame for them, too-- circa 2007, you saw as many of those on college campuses as you did MacBooks or netbooks. No longer.

I feel like HP made a tactical error by eliminating the Compaq brand for their garbage products. It feels like car companies have the right idea - Toyata/Lexus, Honda/Acura, Chevy/Buick, and so on. If HP had used Compaq for their low-end cheap products, they might not have reaped as much profit in that space as the HP brand got them, but the HP name might still mean something. Now the HP brand is worthless.

As I read this on my own hideous Pavilion. It has a keyboard designed by catbert.

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