By Ben Hirschler
LONDON, Feb 28 (Reuters - How to measure medical corruption? Tuan Anh Nguyen, a researcher at Hanoi University of Pharmacy, believes informal payments to doctors are "a dominant factor" in high prices of the older off-patent drugs that make up the lion's share of prescriptions in many emerging markets.
After interviewing doctors, pharmaceutical companies, government officials and pharmacists in both the private and state hospital sectors, he concluded in a study published last year that around 40 percent of the drugs' price in Vietnam is typically spent on offering financial inducements to doctors.
"When I talk to colleagues in some other Asian countries they say the situation is the same," he told Reuters.
His investigation broke down the different legal and illegal components that contribute to the cost of drugs in Vietnam, and found 40 to 60 percent of the final price could be spent to induce prescribers to use particular medicines, and to persuade procurement officers inside hospitals to buy them. The biggest share went to doctors.
Nguyen said the problem was worse with generic medicines sold by Asian companies, although his study did not name any firms. In Vietnam the price of these is sometimes even higher than that of the original branded product, in order to recoup payments made to doctors by drug companies trading these medicines.
But Western drug firms are not immune: pharmaceutical company representatives who spoke to Nguyen reported that doctors typically expect a commission of about 15 percent from European drug makers; the figure they look for from Asian producers is nearer 40 percent.
The study, which was presented at the International Conference for Improving Medicines in Antalya, Turkey, last October, found multinational companies tend to prohibit bribes, officially at least, although pressure to achieve sales targets often means representatives ignore this and give money to prescribers.
At other times, multinationals pay for one-off benefits like luxury holidays that would be prohibited under anti-kickback rules adopted by the drug industry in the United States.
Doctors surveyed said they took the cash and non-cash offers to make up for low salaries, and it was common for commissions from the pharmaceutical industry to become the main source of income for some physicians, leaving those reputable doctors who are determined to stay "clean" out in the cold.
It's a situation one foreign drug salesman says has turned the system upside down: "Now, the worse the doctors, the more money they have. It's ridiculous."
Illegal internet pharmacies are selling illicit drugs and prescription medicines online and are increasingly targeting young people, a UN drug agency warns.
New research suggests that stable heart patients with stents are no better off then patients less costly drug regimens.
MASSDEVICE ON CALL — Patients rushed to the hospital for a heart attack are no better off with a stent than they would be with less-costly drug therapy, according to a new study.
Implanting a stent to prop open blocked arteries represents a more costly alternative that failed to improve patient outcomes, according to researchers from the Stony Brook University Medical Center in New York.
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Bribes paid to foreign doctors and other state employees are shaping up as the next major legal liability threat for the global drug industry
FOR the past three decades the Revolutionary Armed Forces of Colombia (FARC have been almost synonymous with kidnapping. In the mid-1990s Colombia was seen as the kidnapping capital of the world with more than 2500 abductions a year, most attributed to the FARC. The guerrillas financed much of their war against the Colombian state with ransom payments, and sought to put pressure on the government by taking political hostages. Now, after years of setbacks at the hands of the army, the group says it is ready to break with this grim past.
On February 26th the FARC declared they would renounce kidnapping for ransom. In a
communique posted on their website and signed by their ruling secretariat, they announced they would “proscribe the practice [of kidnapping] as part of our revolutionary actions.” They also promised to free the ten remaining members of Colombian security forces they hold as “prisoners of war”, some of whom have been captive for as long as 14 years. That would represent the abandonment of a long-held demand that the government release jailed FARC members in exchange for the group’s military and political hostages.
The FARC are on their heels thanks to a relentless campaign against them by the government over the last decade. With the help of billions of dollars in military aid from the United States, the army has taken out a series of FARC leaders, including its
top commander, Alfonso Cano, last November. Meanwhile, desertions and captures have depleted the guerrillas’ ranks. The FARC’s decision to end kidnapping, says Luis Eduardo Celis of the New Rainbow Corporation, a Bogota-based think tank, is probably a tactical sacrifice intended to help open peace talks with the government.
Any negotiated settlement, however, remains a long way off. First, the FARC have a credibility problem. They made a similar declaration of ending abductions in the mid-1980s, only to expand their kidnapping operations. By 2000, during failed peace talks with the government, the group announced the so-called “Law 002”, which stated that any person or company operating in Colombia with over $1m in assets had to give 10% to the FARC or be abducted. The guerrillas also kidnapped politicians to use as bargaining chips with the government.
Second, kidnapping is hardly the FARC’s only means of threatening public safety. According to the defence ministry, in 2011 the FARC was responsible for 77 abductions, a steep drop from its historical average. But the group has compensated for its declining ransom income by stepping up its businesses in extortion, drug trafficking and illegal gold mining. And in the past month the group has attacked two police stations, killing 15 people and wounding nearly 100, most of them civilians. On February 23rd a civilian who refused orders from the FARC to lead an explosives-loaded donkey in front of an army camp said he was tortured by having his fingers crushed and his mouth sewn up with wire before escaping to a hospital.
Following the FARC’s announcement, Juan Manuel Santos, the president, called it an “important though insufficient step in the right direction.” To open peace talks, he has demanded the group end forced recruitment, the use of land mines and the targeting of civilians. If he can maintain enough pressure on the FARC to extract those concessions, the possibility of peace talks could become a powerful argument in his 2014 re-election campaign.
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