Showing posts with label Philip Stevens. Show all posts
Showing posts with label Philip Stevens. Show all posts

Friday, February 23, 2018

IPR and Innovation 41, Governments and the UN on patent prizes

I am reposting below a good article by a friend. Enjoy.
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How governments can screw up the development of new drugs
by Philip Stevens

THE PATENT-BASED system of drug development will come under further pressure from key countries aiming to increase access to medicines at the executive board meeting World Health Organization in March.

Critics of the system want reform, arguing it makes drugs too expensive and fails to provide cures for those in need who may be unable to pay, such as people in developing countries. They want to slash drug prices by replacing intellectual property rights with government-funded prizes as the primary innovation incentive for medicines.

Developers of new drugs would gain government cash prize rewards for the successful development of a new medicine.

In return, companies would be forced to hand over their intellectual property rights to the government, allowing generic manufacturers to enter the market immediately. Competition between generic drug manufacturers would boost access to those in need as new drugs would be sold at their marginal cost of manufacture, so the theory goes.

Meanwhile, governments would control and plan what disease areas are rewarded by prizes, ensuring that funding is allocated to health priorities in a fair and transparent fashion.

“Delinking” the cost of R&D from the final price paid for a medicine, and making governments the funders and planners of drug development, sounds like a simple public health care solution. But so far, no country has taken the plunge.

This is not surprising; “delinkage” is not the silver bullet claimed by its supporters.

One charge leveled against the patent-based system is that it creates losses for patients by inflating medicine prices well beyond their manufacturing costs. This downplays the economic benefits of new medical technologies from averted hospitalization and fewer sick days for workers. But more to the point, an innovation system based on prizes could create just as many, if not more, economic losses.

The prizes fund would have to come from taxpayers; their burden would be at least the $141 billion spent by the private sector on R&D each year. Income tax hikes would distort labor markets and interfere with job creation.

Then there would be the added costs of the enormous new bureaucracy to manage the prizes system.

In the absence of private sector investment, which country would be willing to fill this funding gap? Here the rhetoric of many countries, including India, at World Health Organization meetings in Geneva has not been matched by serious action. Even modest WHO R&D delinkage “demonstration projects” fall $73 million short of the $85 million required, with contributions from only 10 countries.

This new world of government-funded prizes to drive medicine innovation does not look promising.

Money apart, designing prizes that work is even more of a problem. Government committees would struggle to determine the true economic and social value of medicine before it is even created.

With estimates for developing a new medicine between $1.2 billion and $2.6 billion, this matters a whole lot.

For prizes lower than the true market value of the invention, drug developers — and the venture capitalists so instrumental for start-ups — would direct their capital away from medicine R&D towards politically safer but less socially useful areas. New medicines would dry up.

If a government prize committee overvalues the prize, it would trigger duplication of R&D as competitors swarm. Curious then that proponents of these prizes argue they will end the supposedly “wasteful” and duplicative R&D under the patent system.

Finally, there is the problem of politicization. A prize system would hand significant new discretionary powers to government officials as the judges of which medicines win prizes. Political factors would influence decisions on where to allocate funding, rather than clinical need. Diseases that could summon the most vocal lobby groups would get attention from prize bureaucrats, while less fashionable diseases may be ignored.

Political connections and lobbying could both play a role in securing a prize, while elected officials may attempt to influence R&D spending by government agencies.

Patents, on the other hand, represent a far less arbitrary form of innovation incentive. Government merely sets the framework of patent law, under which all companies compete. And competition is the key to innovation.

Take hepatitis C, until recently an incurable disease afflicting around 12 million Indians. Since 2013, no fewer than 10 new treatments have come onto the market, offering clinicians a huge range of options. Such breadth and speed of innovation under a winner-takes-all prize system is hard to picture.

Despite their superficial attraction, no country (other than the technologically backward former Soviet Union) has yet replaced intellectual property rights with prizes. The reasons are clear. Prizes risk economic distortions, undermining incentives for innovators, and adding a new layer of bureaucratization and politics. Be warned, therefore: delinkage and drug development do not go hand in hand.


Philip Stevens is director of Geneva Network, a UK-based research organization focusing on trade, innovation and health policy.
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See also: 

Sunday, May 08, 2016

IPR and Innovation 34, When 95% of WHO's EML are off-patent

I am reposting this good article by a good friend, Philip. Enjoy.



MAY 3 — Debates on how to improve healthcare in developing countries often start from the same premise: patents can potentially raise drug prices, so they should be abolished for better public health.

In the early 2000s this argument drove the campaign against patents on HIV drugs in South Africa. This week it is motivating campaigners against the Regional Comprehensive Economic Partnership in Asia — a proposed Free Trade Agreement between 16 Asian countries that may impose new intellectual requirements.

NGO disquiet about drug patents has even led to the creation of a UN High Level panel on access to medicines, due to report its recommendations in New York next month.

Such concerns may in fact be overblown. This is an implication of an interesting new study by researchers at the University of Ottawa and published in April by the World Intellectual Property Organization (WIPO) in Geneva.

To better understand how patents impact access to medicines, the researchers counted how many of the World Health Organisation’s (WHO) List of Essential Medicines are subject to patent protection in developing countries. This list contains 375 or so medicines considered most important by WHO experts.

It’s a hugely influential list, and one based purely on the clinical usefulness of a medicine, not cost or patent status. Developing country governments and large international donors use it to guide which medicines they will procure.

The researchers checked national patent registries in developing countries and double-checked with manufacturers. They found that patents for 95 per cent medicines on the list had expired.

Put simply, patents are not relevant to the vast majority of drugs typically used by physicians in developing countries.

Most of the remaining 5 per cent of medicines — around 20 products — on the WHO list with patent protection are for HIV/AIDS. But patent owners either don’t register or enforce their patents in the poorest countries. For middle-income countries, manufacturers often enter into voluntary licensing deals with generic manufacturers to broaden access, meaning there are cheap generic copies on the international market.

The one medicine with no generic equivalent is the cancer drug, bevacizumab (marketed as Avastin by Swiss patent-owner Roche). This modern so-called ‘biologic’ drug is used against many cancers, and works by starving tumours of their blood supply through blocking a key protein.

Patented or not, these biologic drugs are difficult for generic competitors to copy cheaply.

Unlike most drugs, which are chemically synthesised and made from just a few  molecules, biologic drugs are manufactured in living systems such as plant or animal cells, and have complex molecular structures. Their manufacture demands significant investment and technical know-how, meaning such drugs will never be as cheap as, say, generic aspirin.

One implication of the study is that if patents were abolished tomorrow it would make little difference to the cost or availability of most medicines used in developing countries.

Even so, these medicines are frequently unavailable in public health systems.

In 2014, researchers at the University of Utrecht in the Netherlands found that, on average, essential medicines are available in public sector facilities in developing countries only 40% of the time.

While generic medicines are cheap to make with no royalties to pay, they are still too costly for most people in developing countries.

One example from the WHO list is budesonide, commonly used by asthma sufferers. A single inhaler costs a staggering 50 days wages in Mozambique. In the US, one inhaler costs only US$5 to US$7 (RM20 to RM27) — around 30 minutes work on the median hourly wage.

The reasons behind the expense and scarcity of essential medicines in developing countries are complex, but failures of governance loom large.

Mark-ups along the distribution chain inflate the final price of medicines and include import tariffs, sales taxes, value-added taxes and retailers’ and wholesalers’ margins. In Kenya, mark-ups add 300 per cent to the manufacturer’s price; in Brazil it’s 200 per cent, says IMS, the global healthcare data provider.

Dysfunctional medicine supply chain management is another culprit. A 2015 survey by humanitarian NGO Medecins Sans Frontières reported one in three health facilities in South Africa have shortages of key HIV and tuberculosis drugs. The drugs are imported in sufficient quantities but fail to reach patients due to “local logistical and management problems, ranging from inaccurate forecasting to storage or transport issues”, said MSF.

Governments under-invest in health too. While most European Union countries commit 8 per cent to 11 per cent of GDP to health, few Asian and African countries spend more than 5 per cent: not nearly enough given their enormous health challenges.

These are the major influences on access to medicines. Public health would be best served if the political focus were on these issues, rather than patents.

* Philip Stevens is senior fellow at the Southeast Asia Network for Development (SEANET) and director of Geneva Network, a research organisation focusing on health, intellectual property and trade.
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See also:

Friday, July 17, 2015

IPR and Medicines 35, New paper from Geneva Network

Minimal Government Thinkers, Inc. is a partner of two international free market network dealing with property rights protection including intellectual property rights (IPR) -- the Property Rights Alliance (PRA, based in the US) and the Geneva Network (GN, based in UK). PRA is an old, established network and among its important projects is the production of the International Property Rights Index (IPRI) annually. GN is a new network, born only this year and it produces occasional papers and holds some public events/lectures from time to time. PRA is headed by Lorenzo Montanari and GN is headed by Philip Stevens, both are good friends of mine.

GN has produced this week a new paper, 3-pages The TPP, data exclusivity and public spending on medicines. The Trans-Pacific Partnership (TPP) negotiations create a number of conspiracy theories that are, well, unsubstantiated conspiracies. Like if period of regulatory data protection (RDP) aka "data exclusivity" for biologic medicines is increased, then it will increase public spending on new, essential medicines and reduce public access to them and hence, adversely affect public health.

GN Director Philip Stevens showed data that when Canada increased RDP from 0 to 8 years in 2006, it did not result in any rise in pharma expenditures/total health expenditures (THE). Japan also increased RDP from 6 to 8 years in 2007, there was no significant increase in the ratio in the succeeding years.

Phil concluded his paper with this observation,

"There could be many explanations for this result, ranging from changes in procurement policies to increases in the number of medicines that whose patent terms have expired. The evidence presented above, however, suggests that those concerned about access to medicines and the financial sustainability of public healthcare systems should focus their attention on policies other than Regulatory Data Protection for medicines."

Good paper Phil, as usual.
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Friday, May 22, 2015

IPR and Medicines 33, Geneva Network's Forum in Singapore

Our friends and allies, Geneva Network (UK-based) and Southeast Asia Network for Development (SEANET, Malaysia-based) held a forum yesterday morning in Singapore on the TPP, Health and IPR. 


Background of  the forum:

This week, trade negotiators from some of the world’s most powerful economies are meeting in Guam to thrash out the final stages of the Trans Pacific Partnership.  This free trade agreement – which in Asia includes Singapore, Malaysia, Japan, Vietnam and Brunei – stands to become a significant milestone in the deeper integration of the global economy.

Despite the economic potential of the TPP, one of its cornerstones – stronger intellectual property rights – remains controversial, with health NGOs claiming it will impact public health by raising the price of medicines.

To what extent are such fears justified? Why is intellectual property in this trade agreement important for the future of medical innovation? And what does the TPP mean for health in the Asia region?

The speakers yesterday were:
(1) Prof Elizabeth Siew Kuan Ng, Faculty of Law, National Univ. of Singapore (NUS)
(2) Philip Stevens, Director, Geneva Network, UK
(3) Bill Claxton, Carcinoid & NeuroEndocrine Tumour Society
(4) Andrew Spiegel, Global Colon Cancer Association, and 
(5) Mo Mayrides, Associate VP, PhRMA, USA. 

Moderator was Dr. Debora Elms, Executive Director, Asian Trade Centre, Singapore.


I am reposting below tweets by  @SEANET_asia yesterday. All photos here are also from SEANET. Come, follow SEANET on  twitter and facebook, thanks.

(1) Prof Elizabeth Ng begins by introducing the countries involved in #TPP and how negotiation will impact the countries.

No one should begrudge that patent owners deserve adequate protection of returns from investment of considerable resources.

TPP Provision : Patent term extension, data exclusivity, including biologics and patent linkage.

It's often argued that stronger IP foster econ growth, but counter agreement is flow of FDIs is not solely on property rights.

What are challenges to incorporate in regional system?

1. Restriction on trips flexibilities eg: data exclusivity
2 : Lack of skilled patent examiners and other skilled workforce.
3. Access to medicine for the poor : price increases and lack of access to affordable generics.

#ASEAN #TPP countries - how do you further enhance corporation with AEC happening when only 4 ASEAN countries are involved?

The tension between patent protection and access for public health is unlikely to abate.

it is understandable the pharma industry feels justified to seek stronger patent protection

Protection and access must be appropriately calibrated in order to achieve balance between public interest and private interest.

(2) Philip Stevens from @genevanetwork : It's unlikely that there will be changes to the provisions on data inclusivity for chemical drugs.

If #IP protection increases in Malaysia, companies will set up R&D facilities.

No one has done cost benefit analysis on the impact heightened #IP provisions on the availability of medicines in developing countries.

There is a positive relationship between trade liberalisation and better health outcomes.

How? Economic liberalisation increases incomes - allows people to get better nutrition and sanitation.

(3) Bill Claxton of Carcinoid & NeuroEndocrine Tumour Society discusses how innovative medical care has improved his life.

As a patient advocate, I have become increasingly impressed with how pharmaceutical companies support patient groups.

#TPP we need to protect innovators and incentivise their efforts.

Clinical trial can't work for rare diseases. Many trial fails because of trial designs.

If you look at the debate of 5/7/12 yrs for data protection - it won't make a huge difference in rare disease community.

We are looking for a balance between protection and access between public interest and private interest.

(4) Mo Mayrides, Assoc VP of PhRMA representing industry views on #IP in the #TPP

I don't see how the #TPP would deny governments the right to public health access.

(5) Andrew Spiegel from Global Cancer Association who traveled from Philadelphia to attend the panel this morning

Patients that are diagnosed with colon cancer are living longer and more comfortably as a result of innovative biological drugs

Biologics have had tremendous impact on medicine, but there is still a long way to go

Investments will not occur in medical technology if there is no #IP protection

The scary part is if innovation stops, we would rather medicine get delayed into market than not being made all.

Open Forum, questions:

(a) Biggest barrier to #TPP is American public opinion. Do all patient advocacy groups align w your perspectives?

Andrew : Declaration of support among patient advocacy groups on #IP protection, 100 groups signed and delivered to President Obama

Bill Claxton:Patient groups are not well informed on this issue. It is possible to get a consensus view.Patient advocacy is an emerging area.

Dr Elms : Hypothetically, there is some time for patient groups to get mobilised by end of the year.

(b) Question ; How long does it take for medicine to be made and the cost?

Mo : Study from Tufts University - Cost is 2.6 USD Billion and takes 2-6 years to develop. Takes 7- 8 years before any return on investment.

Critics will say the cost is overblown. But costs have gone up in recent years.



I was supposed to attend that forum yesterday. Geneva Network's Director Philip Stevens invited me. But before I purchased my plane ticket last Saturday, an invite came from T/A Trade Advisory and the DFA, WTO chief in Manila, a "by invitation only" roundtable discussion, updates about the multilateral trading system, same day. I chose the later, no cost to me and the SG organizers.
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Wednesday, March 06, 2013

EMHN 8: Brand Protection and Safe Medicines

Our international health network has produced another good paper, Fake medicines in Asia The importance of brands to medicine quality. Authored by a good friend Philip Stevens, this six pages long paper is able to argue that corporate brand protection and brand competition coupled with rule of law, are the best way to protect the public from counterfeit and/or substandard medicines.

Fake or substandard drugs are dangerous and can be fatal. Either the patient does not get well, allowing the disease inside the body to mutate and become more serious, or the drug causes several adverse reactions and trigger more diseases and complications. 

As the "cheaper medicines" mantra is all over the country and the planet, somehow it gives an opening to dirty businessmen to offer really cheap but fake or substandard medicines. They do this by introducing unknown or lesser known brands to non-suspecting patients and drugstores. Or they simply copy the logo, brand and trademark of some known drug manufacturers, innovator or generic, and sell cheap.

The chief government regulating agency is the Food and Drugs Administration (FDA, http://www.fda.gov.ph/ in the Philippines, http://www.fda.gov/ in the US, and so on). The big problem is that this small bureau is mandated to check on the quality of (a) drugs, medicines and vaccines for humans, (b) drugs, vaccines for animals and fishes, (c) food/drink supplements and vitamins, (d) food and juice ingredients, sauces, etc., (e) perfumes, shampoo, soap, detergents, body odor spray, etc., (f) poisonous substances like insecticides and pesticides, and many others.

I think these products constitute at least 10 percent of the total output of the economy. FDA therefore, should have pharmacists, doctors, dentists, chemists, physicists, biologists, engineers, on top of having lawyers and administrators. Is it possible to have such an agency with supposedly super-technical powers and capability to minimize or control mistakes in doing its functions? I really doubt it.

One way to minimize risks and threats to public health, is to devolve product quality to the manufacturers and traders themselves, via brand protection and competition. Like "Jollibbee or McDonalds burger yan", "Starbucks or UCC or Figaro coffee yan", "Pfizer or GSK or Unilab or Pharex medicines yan", "Mercury or Watsons or The Generics yan", and so on. Consumers hold on to the brand as generally safe and these companies do all they can to avoid not even a single, not one, case of food or drinks or drug poisoning. 

Thus, products of these brands will be given minimal regulations and approval process. The main regulator for these brands and companies is the fear of being blacklisted or boycotted or sued by consumers due to bad or unhealthy products. Since these are huge if not global brands, the thought of being put in a bad light scares them more than the peering eyes of a few inspectors from the regulatory agency. Then the latter can focus their energy and resources on new products and brands. Shrewd and opportunist businessmen can put up a company and sell bad products and services that can harm public health. When the company is blacklisted, they simply close down the company and put up a "new" one and create new schemes to fool the public.

The sub-topics discussed by the paper are:

* Limits of regulation
* Brand competition and drug quality
* Intellectual property and brand integrity
* Brands are not just for multinationals
* Rule of law in defending brands
* Technological solutions to fake medicines
* Malysia's meditag scheme
* 2D and QR barcodes
* Dangers of government-mandated technology

And the paper's brief conclusions are:
The most fundamental cause of the spread of fake drugs in Asia has been the inability of manufacturers to protect the identity of their products. This is largely down to a lack of functioning rule of law, which makes it very difficult for manufacturers to protect their trademarks and brands via the civil and criminal courts – thereby handing a free rein to counterfeiters. The extra regulation called for by many commentators may well entrench the corrupt relationship between criminals and certain drug regulators. 
Strengthening the rule of law is a vital but long-term process. In the meantime, the private sector should take advantage of its innovative capacity to experiment with different technological solutions to brand infringement. It is well placed to lead this process, as it has unparalleled access to the entire pharmaceutical supply chain, as well as the clear financial incentive to protect its revenue. Governments should encourage this process, but refrain from mandating specific technologies or systems.

This new paper is another good reference for both government administrators and healthcare advocates in the country or abroad. Markets work. And though there are indeed market failures, there are also market solutions to such failures. Government simply have to focus on only one thing: rule of law. Private players and enterprises should do what they say they are supposed to do, and not offer counterfeits or substandard if not entirely useless products and services. If they don't, existing  governmentregulations and the penalty system should be slapped on them. No exception and no one can grant an exception. The law applies equally to unequal people.
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See also:
On IPR Abolition 12: Patent, Mini-Monopolies and Trademark, September 20, 2011
EMHN 4: Free Trade, TPP and Public Health Protection, January 13, 2013
EMHN 5: Free Trade and Markets in Healthcare, January 17. 2013 
EMHN 6: Fake Medicines in Asia, February 15, 2013

EMHN 7: Free Trade Improves Public Health, February 26, 2013

Tuesday, February 26, 2013

EMHN 7: Free Trade Improves Public Health

Our regional and global health alliance, the Emerging Markets Health Network (EMHN), has republished a paper that was released February 2012 by the Free Market Foundation (FMF) of South Africa. MG Thinkers was a co-publisher of that paper.  See here,  Free Trade 24: Trade and Improving Health Outcome (February 15, 2012).

EMHN Executive Director, Philip Stevens, partnered with two young economists from South Africa, Urbach and Wills, in producing this econometric paper.

Here is the paper's Abstract::


A recurrent theme of the academic literature and wider public discourse is that free trade harms the poor by promoting economic inequality and insecurity, polluting the environment and making processed foods more widely available. All of these factors are deemed to be deleterious to health.

However, there has been little empirical evidence to  support these assertions, in particular the relationship  between free trade and health. This is an important relationship, as it tells us more about the effect of economic policies on human welfare than bald statistics related to GDP...


Contrary to much of the literature, our analysis finds that free trade does in fact promote better health outcomes, with the relationship particularly pronounced for lower-income countries. 

There are two mechanisms that might be responsible for this relationship. On the one hand, trade promotes economic growth, which in turn provides greater sums for individuals to improve their living conditions and for authorities to spend on public health measures such as sanitation and universal vaccination. Another mechanism is ‘knowledge spillover’, wherein international trade increases the global diffusion of both knowledge and products that improve health -- ranging from the basics of germ theory to modern pharmaceuticals and medical devices.


It's a better and cool explanation than the trade-paranoid argument. More trade means more options, more choices for the consumers including patients. Less trade means less options, simple. These two charts are self-expalanatory: more trade means more economic activities, more wealth for the people and thus, the average life expectancy is rising. The second chart shows that more trade, more economic prosperity  translates to less infant mortality.



See the full, 16 pages report here.
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See also:EMHN 3: Penang Workshop Report, September 10, 2012
EMHN 4: Free Trade, TPP and Public Health Protection, January 13, 2013

EMHN 5: Free Trade and Markets in Healthcare, January 17. 2013 
EMHN 6: Fake Medicines in Asia, February 15, 2013

Friday, February 15, 2013

EMHN 6: Fake Medicines in Asia

Our regional health group, the Emerging Markets Health Network, has produced a new paper, EMHN Briefing No. 1: Fake Medicines in Asia. Authored by Philip Stevens and Helmy Haja Mydin, the paper has argued that 

Fake medicines - which are either criminally motivated or the result of lax manufacturing standards - are a worsening problem, particularly in Asia. In some of poorer parts of the continent, up to a quarter of medicines fail quality tests. 
Evidence shows that cheap generic drugs are the most faked medicines in Asia, although there appears to be a particular problem with anti-malarial drugs in places such as Laos and Cambodia. China and India appear to be production hotspots. 
Producers and purveyors of fake medicines are exploiting the increasing globalisation of the pharmaceutical supply chain, poorly defined and  enforced civil and criminal laws, and a lack of an international definition
of what legally constitutes a fake medicine. 

Below is one of the graphics contained in the report. About 40 percent of the pharma crime incidents in 2011 occurred in Asia, followed by Latin America and Europe. I am just wondering why incidents in Africa constituted only three percent of the total. This could be a result of under-reporting of such incidents in Africa, or other factors.


The presence of counterfeit or substandard drugs is a problem here in the Philippines. One time, an anesthesiologist friend told me, a patient was lying on the operating table, surgeons were about to slice his tummy, so the anesthesiologists come first before them. The injected substance is supposed to make the patient feel numb and sleep, within minutes. But after giving the necessary dosage, the patient was still awake and numbness was light. He would be shouting in pain if the surgery would proceed. They realized that they got a fake or substandard anesthesia from one local pharma company that was purchased by the hospital. Right there and then, they scrambled to get another anesthesia as the surgery must proceed that day, otherwise the patient's condition will deteriorate.

So the doctors wrote tot he FDA in a confidential letter to complain about the product of this local company, and the latter knew about their letter, they must have a "mole" inside the agency. This company threatened to sue the doctors for criticizing their company. I offered to write about the story but the physicians were hesitant to give me full details as it is still under FDA investigation. 

The report did mention about the case of fake medicines in the Philippines.


How to solve this increasing problem? The usual solution by many groups is... more legislation, more government. The authors, and I agree with them, caution against this move. They wrote,
In countries where the rule of law is weak, the creation of new regulatory layers and tougher criminal sanctions may be counterproductive, as new powers for regulators create opportunities for bribery and corruption.   
To be effective, stiffer criminal penalties depend on an efficient and fair rule of law, something which does not exist in many Asian countries, particularly the poorer ones which have the greatest problem.
Stronger criminal penalties will likely drive activities further into the hands of organised criminal cells and will also likely result in further corruption, as the criminal cells seek to infiltrate law-enforcement agencies. The fake medicines trade is already showing worrying signs of mafiaisation, with organised crime groups such as Chinese triads and Mexican drug gangs all becoming implicated in the trade over the past decade. 
More effective solutions must address its fundamental cause, which revolve around the inability of legitimate manufacturers to protect the integrity of their brands. Legal reforms can go some way towards addressing these problems, as can innovative uses of technology. 

Protection of intellectual property rights (IPR) like patent and trademarks, enforcement of existing laws against such bad practices, or simply promulgate the rule of law, is the best thing that governments can do, not the creation of new and more regulations and laws.

Civil society groups concerned with or engaged in public health issues would better focus their energy more in battling this bigger problem of proliferating fake medicines, instead of circumventing or disrespecting IPR. As the report noted, the more faked medicines are the known branded generics more than the innovator drugs.

EMHN is a project of the Institute for Democracy and Economic Affairs (IDEAS) in Kuala Lumpur.
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See also:
EMHN 2: IDEAS Forum in Penang, Malaysia, September 01, 2012
EMHN 3: Penang Workshop Report, September 10, 2012
EMHN 4: Free Trade, TPP and Public Health Protection, January 13, 2013

EMHN 5: Free Trade and Markets in Healthcare, January 17. 2013

Thursday, January 17, 2013

EMHN 5: Free Trade and Markets in Healthcare

Our regional network, the Emerging Markets Health Network (EMHN) has published a new book, hooray!

It was formally launched last week, January 11 at the Indian Institute of Foreign Trade in Calcutta. Among the major arguments of the book are: 

* Free trade is a powerful agent of improved health, via higher incomes and ‘knowledge spillovers’ 

* Asian governments stand to benefit from enormous savings if they properly open their health sectors to international trade 

* Intellectual property provisions within international trade regimes have little bearing on access to medicines by the poor, and recent attempts by government to expropriate the property rights of foreign pharmaceutical companies are motivated more by industrial policy than concern for patients 

* New technology rather than new regulation is the most sensible answer to stemming the global trade in fake and spurious medicines.

A longer discussion about the book is found here

Details of the launch are found here. Photos below lifted from that link. Upper photo includes the two editors, Debashis Chakraborty (left most) and Philip Stevens (right most).



The book has seven chapters from eight contributors including the two editors, and me. The book should be ready for sale and distribution in the next few weeks. The publisher made only a few copies for the book launch.

My paper is 14 pages long including tables and references. I am posting below the first two pages :-)
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Universal Health Care and Private Provision in the Philippines

Bienvenido “Nonoy” Oplas, Jr.

I. Introduction

The pursuit of universal healthcare (UHC) or “Kalusugan Pangkalahatan” in Filipino, of providing each of the nearly 100 million Filipinos, access to good healthcare when they need it, is a noble goal. It is a goal that is shared by all stakeholders in the country.

The big question is how to attain it at the most efficient and least costly way, both to the government and households and taxpayers. The dominant thinking is to follow the European and North American models of universal healthcare, in which government takes the dominant role in the healthcare system, and most costs are underwritten by the public purse.  This explains the rising budget for the Department of Health at the national level, and health spending at the Local Government Unit levels. This is not sustainable as the Philippine government is still heavily indebted, even though the debt/GDP ratio has improved compared to a decade ago.

Sunday, January 13, 2013

EMHN 4: Free Trade, TPP and Public Health Protection


Our new global health network, Emerging Markets Health Network (EMHN) has a new website, http://www.emhn.org/. We are composed of independent and private think tanks in emerging Asian countries that believe in greater role for market competition in the provision of healthcare for the people, rich and poor alike.

Last month, EMHN Executive Director and a good friend, Philip Stevens, wrote an article published in WSJ Asia. Philip argued that free trade -- freedom to trade by producers from different countries and freedom to choose by consumers from different countries -- is consistent with protecting public health especially in encouraging the emergence of more powerful, more disease-killer new medicines. The opposition by Oxfam and other left-leaning NGOs to data exclusivity purportedly to protect public health is not valid, Philip argued.

Enjoy reading, cheers.
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http://online.wsj.com/article/SB10001424127887324407504578186882937216070.html#articleTabs%3Darticle

December 18, 2012, 11:41 a.m. ET

Free Trade Is Good for Health

The TPP can improve access to food and medicine. But Oxfam won't tell you that.



Last week, trade negotiators for the Trans Pacific Partnership (TPP) sat down in Auckland to hammer out a deal. This new multilateral trade agreement between the U.S. and ten Asian and Latin American countries could be the largest of its kind since the collapse of World Trade Organization talks in Geneva in 2008, so it's perhaps not surprising that it's coming under a barrage of left-liberal criticism. Oxfam and others now claim the TPP is bad for health.

These development NGOs argue the free-trade pact will impose onerous new forms of intellectual-property protection on essential medicines that go beyond those agreed by the WTO's Trade Related Aspects of Intellectual Property (TRIPS) 1995 agreement. And that this will make it difficult for the world's poor to access cheap drugs. But this is a misperception NGOs are amplifying, ignoring altogether the positive story about free trade and health.

First off, Oxfam's claim that the TPP will reduce access to essential medicines for poorer TPP countries like Vietnam or Peru is factually untrue. The U.S. government has stated that the TPP will respect flexibilities in the TRIPS agreement agreed in Doha in 2001 that allow developing nations to override pharmaceutical IP rights in a number of circumstances, including health emergencies.

Next, the vast majority of drugs on the World Health Organization's list of essential medicines to treat the most common infectious diseases are off-patent. So IP rules are simply irrelevant to drugs for many conditions prevalent in the poorest countries.

The same is true for common medicines used to treat the most prevalent non-communicable diseases faced by slightly wealthier TPP countries such as Malaysia. So many medicines for diabetes, hypertension and asthma are completely outside the scope of any free-trade agreement.

Still, NGOs raise the specter that the TPP will sidestep traditional patent rules by imposing punitive new periods of "data exclusivity" for essential medicines. Data exclusivity is a form of intellectual property that allows manufacturers of new drugs to retain the right to valuable data generated during clinical trials. The idea is to prevent generic manufacturers from using it to make copies until a fixed period elapses—typically five years in most countries.

Data exclusivity is rapidly surpassing patents as the most important form of intellectual property for medicines, as the 20-year term of a standard patent is increasingly eaten up by lengthy testing and regulatory requirements that drive up R&D costs. After jumping though these hurdles, an innovative medicine typically has around only seven years patent life to recoup costs and make a profit.

Absent radical reform of the drug approval system—which is unlikely to happen any time soon—data exclusivity is then the best assurance innovators have that their investments will reap a return. Otherwise, launching a new drug could become so expensive that patients may not have access to new medicines. That's why such considerations are now included in modern trade deals.

Despite what Oxfam thinks however, the chances that the TPP will lengthen the exclusivity period are very low. The five years of exclusivity for new standard chemical drugs is enshrined in U.S. law, so Washington cannot ask for more in trade negotiations.

Five years is also the standard to which other TPP countries like Vietnam and Malaysia subscribe, so it isn't clear they'll push for more. In any case, the TPP will probably only apply data exclusivity to new drugs, meaning that existing drugs remain unaffected.

Yet in the end, intellectual property and the NGO community's fulminations against it are a sideshow in the wider story about trade and health. These activists and their intellectual backers like to view free trade as somewhere between an agent of imperialist economic repression and a sinister vehicle for America's fast food industry, but the reality is that there have been few more powerful forces for improving health in the history of humanity.

Prior to the 1950s, the majority of the world's population lived a precarious life as subsistence farmers. Since then, the opening of global markets, first by the General Agreement on Tariffs and Trade and then by the WTO, has transformed the health prospects of millions by raising incomes. That, and not IP flexibility, made decent food, sanitation, and new medical technologies available.

That's how the Asian countries involved in the TPP—Malaysia, Singapore, Brunei and Vietnam—have witnessed startling improvements in the health prospects of their citizens since the middle of the last century. Singapore signed GATT in 1973, and by 1993 there were no import duties for any product except alcohol, tobacco and automobiles, a situation that largely persists today. Singapore now surpasses many European countries for life expectancy, with Malaysia not far behind.

Each of these countries has reaped enormous welfare dividends by opening their borders to free trade. With poorer countries such as Vietnam now joining the party, millions could benefit from the TPP—provided they are not put off by scaremongering NGOs.

Mr. Stevens is executive director of the Emerging Markets Health Network at the Institute of Democracy and Economic Affairs (IDEAS), Malaysia.
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See also:
EMHN 1: Forum on Promoting Markets in Healthcare, IDEAS-Malaysia, June 23, 2012
EMHN 2: IDEAS Forum in Penang, Malaysia, September 01, 2012
EMHN 3: Penang Workshop Report, Seotember 10, 2012

Monday, September 10, 2012

Fat-Free Econ 23: Penang Workshop on Markets in Healthcare

* This is my article today in TV5's news portal,
http://www.interaksyon.com/business/42796/fat-free-economics-healthcare-as-right-responsibility
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PENANG, Malaysia – Healthcare is a right and an entitlement, a public good that must be provided by the government at the highest quality and at the lowest or zero cost possible. And some people can sit back as this high social expectation and low personal obligation is supposed to be provided by the government.

That is a formula for high disappointment and social conflict, both in the present and in the future. While it is true that healthcare is a right, it is also a responsibility, a personal and parental, guardian, and civil society responsibility, with or without government assistance. Rights without responsibilities, entitlements without obligations, will encourage politically noisy but economically lazy citizens. And society cannot progress in such condition.

Our seminar on “Promoting Markets in Healthcare” ended Sunday. Participants from independent think tanks from China, India, Indonesia, Malaysia and the Philippines exchanged notes on how civil society and the private sector can optimally provide healthcare to the public at the least politics, least coercion and taxation possible. The event was sponsored by a new global think tank, the Emerging Markets Health Network based in London, and the Institute for Democracy and Economic Affairs based in Kuala Lumpur. Both are espousing free market and more individual freedom philosophy.

There were several presentations made by speakers from different countries. Liew Chin Tong, a member of the Malaysian Federal Parliament, observed that the federal government is acting like a businessman in healthcare, banking and many other sectors as the government owns many hospitals, including “private” ones. He said the role of the government is to be an enabler, to provide equal opportunity to the people especially the poor, and not as businessman.


Frank Largo, a fellow Filipino who chairs the Department of Economics of the University of San Carlos in Cebu City, said that while healthcare is often an emotional issue, not every case is an emergency, and there is a big role for market and civil society players and providers especially in non-emergency cases. That there is a big gap between curative and preventive healthcare, and that there is bias among many academics, especially health economists, for more government intervention in healthcare.

Dr. Debashis Chakraborty, an economics professor at the Indian Institute of Foreign Trade noted the role of public-private partnership in India in the provision of various healthcare services, the inefficiencies or even absence of government healthcare service in many rural and far flung areas. This provides big opportunity for civil society and market players in non-state provision of healthcare.

Philip Stevens, the founder of EMHN, noted that the National Health Service of the UK government is a healthcare monopoly and is showing various forms of inefficiency like long waiting period for patients, and lack of innovation, which is a common practice in situations where no competition exists.

Prof. Yu Hui of the Chinese Academy of Social Sciences and director of China Research Center for Public Policy, and Prof. Feng Xingyuan of the China Academy of Social Sciences and vice-director of Unirule Institute of Economics, made a joint presentation, “Development of Private Hospitals in China and Lessons for Other Countries”. Below are some of the presentations.


But while there are explicit announcements by the Chinese government to encourage the development of more private hospitals and other healthcare providers, the entrenched interests in the public health sector is making this far from attainable.


They suggested (a) competition for the sector, (b) equal inclusion of private hospitals in the Social Medicare Insurance scheme, (c) privatization of some state-owned hospitals, and (d) mobility of healthcare providers in terms of fair promotion, especially among health professionals in the private sector.

Dr. Chua Hong Teck, director of the Healthcare and Low Income Households, Performance Management and Delivery Unit under the Office of the Prime Minister, presented lots of data about the healthcare system in Malaysia (see below).


Healthcare is the fastest growing sector in the Malaysian government. This is a result of high expectations by both the public and policy makers, that healthcare should be provided to all citizens at the highest quality and at the lowest cost, free for the very poor, as much as possible. This is not happening of course, as the presence of private hospitals is rising, implying there is rising demand and expectations on public healthcare that are not met and provided.

The lower table shows that the number of beds in private hospitals was rising from 2000 to 2011,but the number of health professionals for the same period was declining. This implies one thing: physicians and other health professionals in private hospitals are over-worked or simply more efficient, producing more health services at lower manpower input, while those in public hospitals are underworked or simply bloated. I could be wrong but this is the most proximate explanation that I can see.

Dr. Chua said the following are the challenges for the non-state sector in healthcare: (a) enforcement of Private Healthcare Facilities Act of 1998 with regulations of 2006, (b) financing of these services and management of these facilities, and (c) ability to co-exist and compete with the public healthcare system.

I do not believe that it is possible to have real competition between private and public healthcare providers as favoritism is inherent in the latter. For one, the former is taxed while the latter is subsidized. Second, the former is regulated while the latter is the regulator.

High spending in public healthcare is among the major deficit generators and debt creators in many rich countries now. If a service is provided for free or at highly subsidized rates, expect the demand to be larger than the supply always. The result of such a wide gap between demand and supply is (a) healthcare rationing like long waiting period for non-emergency cases, or (b) generally poor quality delivery or provision of a service, or (c) continued bleeding of fiscal condition with sustained high borrowings to finance the system, or (d) all of the above.

If we recognize that healthcare is a right and a responsibility at the same time, then it should be recognized that those who want good quality healthcare must pay for it as much as possible. This will open up the discussion on the importance of preventive healthcare, that people own their bodies, not the government. So if people will abuse their body, no amount of government healthcare subsidy and borrowings will remedy the situation.

And secondly, recognize the need to deregulate private and civil society health insurance schemes. Government health insurance system like PhilHealth in the Philippines can be retained but people should not be coerced and obliged to become mandatory members and contributors to it. It should co-exist with private and civil society health insurance schemes in order to encourage more competition, more innovation, and more efficiency at least cost possible to the public.

The case of infectious diseases on certain occasions like the spread of leptospirosis during heavy flooding, and pediatric diseases like childhood cancer, can be a separate case where taxpayer-financed healthcare is justified.

Removing or reducing the fat and bureaucracies in government healthcare system is the way not only to help address the bleeding public debt problem in the Philippines and in many other countries, but also to inculcate the age-old dictum: rights and responsibilities, entitlements and obligations go together.
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See also:
EMHN 1: Forum on Promoting Markets in Healthcare, IDEAS-Malaysia, June 23, 2012
EMHN 2: IDEAS Forum in Penang, Malaysia, September 01, 2012
EMHN 3: Penang Workshop Report, September 10, 2012

Fat-Free Econ 8: Drug Price Regulation is Wrong, May 04, 2012
Fat-Free Econ 9: Drug Pricing Bureaucracy is Not Cool, May 11, 2012
Fat-Free Econ 18: Healthcare Corruption and Physician Entanglement, July 30, 2012

Fat-Free Econ 22: Three Years of Drug Price Control Policy, August 30, 2012