Your pills, your food, your doctor, your water — they are all under attack

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Your pills, your food, your doctor, your water — they are all under attack.

Every time you fall ill, America gets a little richer, for we are a billion

dollar market

BY MIRA Shiva

Public Health Activist

IN THE past year America has seen the most violent, nation-dividing debates

about its healthcare system. India could do with some of that energy.

We are short of approximately six lakh doctors, and there is a bigger shortage

of nurses, auxiliary nurse midwives, lab technicians, anaesthetists,

psychiatrists in our public health.

Instead of addressing these shortages, our healthcare is being pushed blindly

towards an American agenda. Budgetary allocation for healthcare is only 0.36

percent of India's GDP and 80 percent of healthcare is privatised. This

privatisation is leading to the pushing of expensive drugs, technology and

vaccines.

The current model is for bigger, costlier medical institutions and doctors who

prescribe to rich patients. With our significantly high maternal, infant and

neonatal mortality, India cannot switch to a privatised, hi-tech, curative care

kind of model that emphasises funding and research.

US-style privatisation basically relies on the market to take care of

everything. What this model forgets is comprehensive healthcare — not a new idea

by any means. It was formulated in 1978 in Alma Ata, currently in Kazakhstan.

India signed the Alma Ata Charter.

The idea was to prioritise healthcare for the majority, irrespective of the

patient's ability to pay, with an appropriate referral system in place for

secondary and tertiary care.

One cannot focus on these while neglecting determinants of health — food, water

and shelter. Curative healthcare alone will treat a person again and again for

typhoid or amoebiasis, yet what is the point if your drinking water is

contaminated by sewage?

The aim was to prevent common health problems, without their becoming more

serious, requiring hospitalisation, along with costly medicines and medical

interventions.

But that was in 1978. Today, the areas of great concern for us should be

biotechnology, Intellectual Property Rights (IPR), food and agriculture.

There is a sustained attempt by the US (and the EU and Japan with whom we signed

free trade agreements) to asphyxiate the generic drugs industry in India. These

drugs are crucial to developing countries.

When Mandela came to power in 1994 in South Africa, the cost of the

antiretroviral AIDS drug was $15,000 a year. The African nation, with its high

incidence of HIV/AIDS,wanted to give its patients cheaper, high-quality generic

equivalents.

The Indian pharma corporation Cipla took on the challenge and produced the

generic antiretrovirals at $350 a year. India supplies 80 percent of AIDS

medicines to developing countries. Obviously, a country using TRIPS

(Trade-Related Aspects of Intellectual Property Rights) flexibility and

supplying cheaper, quality drugs to its HIV positive patients was a commercial

threat. In 2001, around 39 pharmaceutical MNCS took the South African government

to court for violation of intellectual property rights.

An outcry by public health groups, AIDS activists and governments of developing

countries resulted in the Doha Declaration on IPRs and public health in the same

year.

The government of Thailand, too, has faced tremendous pressure from the US for

using TRIPS and compulsory licensing to produce cheaper generic equivalents of

antiretroviral and anti-cancer drugs.

India supplies 80 percent of the AIDS medicines to developing countries.

Obviously, this makes it a commercial threat

Several patented drugs are going to be out of originator's patent protection

soon. Generic equivalents can then be manufactured making the stakes add up to

billions of dollars. So, how do drug companies in the First World stall it? One

way is mergers and acquisitions.

In India, the MRTP (Monopolies and Restrictive Trade Practices) Act used to be a

safeguard against such mergers. Not anymore. Mergers like Ranbaxy-Daiichi and

Piramal-Abbott are going to seriously impact Indian access to many drugs, their

prices, the nature of research and development and where public health

priorities lie.

There are other ways. A coalition of stakeholders calling themselves the

International Medical Products Anti-Counterfeiting Taskforce (IMPACT)was sneaked

into the WHO — shifting the contours of the debate so that the word counterfeit

would be used instead of generic drugs.

(Today, Wikipedia's entry on Anti-Counterfeiting Trade Agreement aligns generic

drugs with counterfeit ones.) The stated intentions of IMPACT has been

challenged at the World Health Assembly by the developing nations.

The health ministries of India, Thailand, Brazil and civil society organisations

like Health Action International (HAI), Third World Network (TWN), Knowledge

Ecology Initiative (KEI), Peoples Health Movement (PHM) expressed their

dissatisfaction with commercial interests guiding IMPACT.

There is also the deceptively titled Partnership for Safe Medicine, an NGO from

the US. Four out of five of its objectives are related to the counterfeit

agenda.

The proposed Anti-Counterfeiting Trade Agreement (ACTA), which is supported by

the US, is the civil and criminal enforcement of IPR.

The issue of safe and unsafe medicines is an important one. Unsafe drugs like

Thalidomide, prescribed during pregnancy, have resulted in the birth of

thousands of babies without limbs. Diethylstilbestrol (DES), also prescribed

during pregnancy, resulted in development of vaginal adenomas in girls once they

grew up, and infertility in case of a boy child. Which is why there is a genuine

concern about Rofecoxib (painkiller), Fluoxetine (anti-depressant) and

Rosiglitazone (anti-diabetic), drugs associated with adverse cardiac effects and

therefore withdrawn in the EU and US.

However, perfectly functional drugs produced in India are acquiring the

connotation of being spurious or substandard. This means the medicines you

export can be destroyed on grounds of suspicion.

The US and EU are pushing for data exclusivity and patent linkage to enable

market protection to originator pharmaceuticals by denying approval to generic

equivalents.

Take Gleevec, the Novartis drug for chronic myeloid leukaemia, which costs Rs.

1.2 lakh a month.

The Indian generic drug costs Rs. 10,000 a month, which is still on the higher

side. Novartis has changed the drug formulation slightly to try and get a new

20-year patent. There has also been pressure from the US to do away with section

3(d) of the Indian Patent Act, which prevents the evergreening or lengthening of

patents.

The other area of great concern is food and agriculture. The US, with its

genetically modified processed food, has massive health problems.

The aggressive marketing of branded processed foods, considered junk food by

nutritionists, are especially targeted at children. Processed foods are filled

with chemicals like monosodium glutamate and are sweetened with genetically

modified high fructose corn syrup.

This is linked to several health problems and, if pushed in India, could worsen

the increasing trend of diabetes and obesity in the young. We have a high

disease burden of poverty, malnutrition and communicable diseases, water and

vector-borne illnesses, STDs and chronic noncommunicable diseases like

hypertension, diabetes, cancers and mental health problems such as stress and

depression.

Drugs produced in India are acquiring the connotation of being spurious.

Medicines we export can be destroyed on grounds of suspicion

With pizzas, noodles and soft drinks, we are opening ourselves to a whole new

set of health hazards. We risk standardising the varieties of food available in

the country.

There is huge pressure to distribute cola drinks and processed food with

government mid-day meals. To make matters worse, the Indian Medical Association

has endorsed Pepsi in the past.

Have the medical associations ever taken on corporations for selling hazardous

drugs or unethical marketing? If these are the people taking decisions on food

and health on our behalf, then we are in big trouble.

When President Obama visits, there are some compromises we should not make

because they will endanger our healthcare.

ACTA should be protested because it is against the interests of public health.

We should not cede to American demands of data exclusivity and patent linkage.

Section 3(d) of the Indian Patent Act should not be repealed at any cost. We

cannot allow potentially toxic or hazardous industries, even if it is considered

a big carrot to attract foreign investment.

We need to make sure we have more than adequate liability clauses related to

vaccines and genetic engineering. The larger determinants of health — food,

water and shelter — cannot be forgotten.

Besides being a national shame, the recent case of the denial of justice to the

victims of the Bhopal gas tragedy raises another important question. Who is

supposed to clean up the toxic effluents?

The tragedy is a stark reminder of the healthcare implications of letting

corporations run loose.

If they cannot keep their flashback responsibility, how will they retain a flash

forward responsibility?

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