India’s Efforts to Aid Poor Worry Drug Makers | Hacker News Reader

India’s Efforts to Aid Poor Worry Drug Makers

nytimes.com

33 pointsvellum42 comments

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.

Kindle Books are cheaper in India? This is news to me. How cheap are they exactly?

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/

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?

I'm from India, and I use the American Kindle store as many books I want to buy are not even available in the Indian store. I haven't checked for a few months though, so things may have improved.

You can switch between them as and when you like. Every book I wanted so far was available on the Indian store. But if the book you want isn't there, you can switch your Kindle region and buy that. Then, later, when you want to get one that is available on the Indian store, you can switch back and get that at a cheaper price!

There may be differences in some cases, but usually western versions of print books tend to be better (color illustrations/pictures, etc.) to justify a higher price. That distinction doesn't really apply to digital books so for the most part, they're the same. (unless there are censorship/localization issues)

I have an even better idea: no pharma patents at all. Instead of relying on private R&D, rely on public funding -- just like we do in other fields of science. Let anyone produce the drugs discovered by that research and bring the focus of research back to drugs that work rather than drugs that are easy to profit from.

I like your idea and also the parallels that you're pointing out. I just can't see it making it through legislation through the pharma lobbies.

It's always tougher to implement these things after there are big players out there.

And your last point is something that touches me personally:

bring the focus of research back to drugs that work rather than drugs that are easy to profit from.

This is a massive problem worth discussing. I had a family member die of a disease which was incurable. One of the big pharma companies had prototypes of the next drug they wanted to bring to the market but their current drug (which didn't work..) hadn't 'run its course'. So they delayed the release of the new one for a few years.

In retrospect, it didn't matter because the new one didn't work either but this kind of practice is heinous on so many levels and must be stopped.

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.

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.

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.

government = corrupt body = money sink

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.

I guess you can safely ignore my comment then :)

"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.

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 :(

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.

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.

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 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.

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.

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.

> 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.

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.

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.

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.

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.

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.

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.

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.

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.

> We don't make nukes with aid money.

Of course, money is fungible.

> I am writing this from the UK where we don't have aircraft carriers or indigenous launch capability anymore.

What are you talking about? The reason you're being downvoted is that trite, inaccurate Daily Mail-ish opinions are just dumb.

The UK doesn't have aircraft carriers because it fucked up the decommissioning / commissioning cycle. HMS Queen Elizabeth will be operational in 2020 [1]. You seem to be implying that a choice has been made to no longer have aircraft carriers in order to prioritise welfare.

And what is Trident if it's not "indigenous launch capability"? When did the UK ever possess land based missile capability?

[1] http://en.wikipedia.org/wiki/Queen_Elizabeth-class_aircraft_...

"indigenous launch capability"

The UK did briefly have the capability to launch satellites with home grown launchers:

http://en.wikipedia.org/wiki/Prospero_%28satellite%29

The UK gave up on ground based launchers as they were far too vulnerable - although the first missile silo designs were actually done for the Blue Streak missile:

http://en.wikipedia.org/wiki/Blue_Streak_missile

The choice was made to decommission the Invincible class early to save money. You can wriggle all you like, that is true.

Trident cannot place satellites in orbit, nor launch probes to Mars (http://www.bbc.co.uk/news/science-environment-24729073).

That's 2 for 2

Wriggling?

What is the HMS Queen Elizabeth? When did the UK ever have the sustained ability to launch into orbit?

Go back to reading the Daily Mail, son, it's a safe place for bigotry.

Show me some Daily Mail links then boy, because I haven't read them. In fact if I were going to guess what paper said "no nukes" I'd say the Grauniad. India's policy of "guns not butter" cannot be justified given the very real issues facing their population.

http://en.wikipedia.org/wiki/Guns_versus_butter_model

What is the Queen Elizabeth? I'm glad you asked. It's a carrier that will come into service at some point in the future and we could not afford to keep a carrier capability going in the meantime. FACT. It's a class of 2 ships, one of which will be mothballed as soon as it is built as we cannot afford to operate it. FACT. The project is ongoing because penalty clauses mean it would cost too much to cancel it. FACT. The aircraft that will operate from it are the second choice as we couldn't afford to fit catapults. FACT.

Shall I go on?

Sigh. I don't know whether you're being sarcastic. You're focusing on a country when we should be thinking about individuals. What I see is a population set that is currently excluded from survival due to the pricing of certain chemicals. This population set exists both in India and in our own backyard. There are 2 ways we can get access to a solution for that population set. One, allow generics to compete after a certain period. This tends to be natural, since reverse engineering a drug takes some time. During that time, big pharma can price the drug to maximize profit, after that, they have to compete better if they want to hold on to that profit.

It's not like India doesn't need its military. Its relationship with Pakistan pretty much demands it. Plus, now they have contested territory with China as well.

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...

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.

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...

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