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Pharmaceutical patents and the quality of mental healthcare in low- and middle-income countries

  • Varuni De Silva (a1) and Raveen Hanwella (a2)
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References
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American Psychiatric Association (2000) Practice Guideline for the Treatment of Patients with Major Depressive Disorder. American Psychiatric Association.
American Psychiatric Association (2004) Practice Guideline for the Treatment of Patients with Schizophrenia. American Psychiatric Association.
Department of Health and Human Services (2006) Approved Drug Products with Therapeutic Equivalence Evaluations (http://www.oig.hhs.gov/publications/orangebook.html).
Dimasi, J. A., Hansen, R.W. & Grabowski, H. G. (2003) The price of innovation: new estimates of drug development costs. Journal of Health Economics, 22, 151185.
European Generic Medicines Association (2004) Evergreening of Pharmaceutical Market Protection (http://www.egagenerics.com/gen-evergrn.htm).
MÉDECINS SANS FRONTIÈRES (2005) A Guide to the Post-2005 World: TRIPS, R&D and Access to Medicines (http://www.msf.org/msfinternational/invoke.cfm?component=article&objectid=88694E5B-0FED-434A-A21EDA1006002653&method=full_html).
National Institute for Clinical Excellence (2002) Schizophrenia Core Interventions in the Treatment and Management of Schizophrenia in Primary and Secondary Care. National Institute for Clinical Excellence.
National Institute for Clinical Excellence (2004) Depression: Management of Depression in Primary and Secondary Care. National Institute for Clinical Excellence.
United Nations Conference on Trade and Development (1996) The TRIPS Agreement and Developing Countries. United Nations Conference on Trade and Development.
World Bank (2006) World Development Indicators database (http://devdata.worldbank.org/wdi2006/contents/Section2.htm).
World Health Organization (2005) Essential Medicines WHO Model List. World Health Organization.
World Trade Organization (1994) Agreement on Trade Related Aspects of Intellectual Property Rights, Marrakesh Agreement Establishing the World Trade Organization, Annex 1C, 33 ILM 81 (1994) (TRIPS) Annex IC Agreement on Trade Related Aspects of Intellectual Property Rights, Including trade in Counterfeit Goods. World Trade Organization.
World Trade Organization (2001) Declaration on the TRIPS Agreement and Public Health. World Trade Organization.
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BJPsych Bulletin
  • ISSN: 0955-6036
  • EISSN: 1472-1473
  • URL: /core/journals/bjpsych-bulletin
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Pharmaceutical patents and the quality of mental healthcare in low- and middle-income countries

  • Varuni De Silva (a1) and Raveen Hanwella (a2)
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eLetters

Need of a paradigm shift

Mahesh Rajasuriya, Consultant Psychiatrist
11 January 2009

TRIPS (Trade Related Aspects of Intellectual Property Right) and WTO (World Trade Organisation) are products of the Western Economic Model. Therefore the problems arising due to them are essentially products of thesame Model. The authors have taken great care to point out these potentialproblems to us.

It is interesting to note that the authors have suggested some remedies as well. Namely differentialprice structures for countries depending on their per capita income, outsourcing manufacturing to countries like India where production costs are low, and tying up with companies which already manufacture clone drugsthat would enable patented drugs to be provided at low cost to low- and middle-income countries.

It is also interesting to note that these remedies, too, are based onthe Western Economic Model. Increasing evidence is accumulating about a collapse or untenable growth of the Western Economies, peaking with the recent collapse of world markets. Hence it is worth asking if these remedies are sound solutions to the problems.

It is essential for pharmaceutical companies to become “ruthless companies” in order to just exist (1). These companies invest burrowed money. The lenders, who give the money, always look for most profitable and expansionist sectors of the global economy, to ensure that their funds, i.e. their means of profit, keep growing (1). Hence in order to attract further funds the pharmaceutical companies have to be ultra-profitable and expansionist, i.e. “ruthless”.

In this context it is naive to hope that pharmaceutical companies would even consider a differential price structure or team up with manufactures of clone drugs. However they are likely to outsource manufacturing to countries like India.

Companies typically move production operations into third world countries for two main reasons (1):1. Third world people are seen as the new consumers in their expanding market. Production is moved to be physically close to the market, in orderto cut costs and improve efficiency.2. In many cases third-world workers have little power. Therefore global corporates do not need to pass the same portion of profit to their third world employees.

In the end this option, too, does not seem to be beneficial in the long run, except for the companies themselves.

In the light of these insights, I believe, it is time for a paradigm shift. We need to think out of the box about coping with today’s challenges, among which ensuring affordable medications for everyone is just one.

References:(1).Tangye, D. Global Enslavement or the collapse of the western economic model [Internet]. Document published on www.blakmaktan.com. [Published October 2001; updated in March 2002]. Available from http://www.blakmaktan.com/GEoCoWEM.pdf.

Author details:Mahesh RajasuriyaConsultant PsychiatristAmpara Mental Health ServiceMental Health Focal PointOffice of Regional Director of Health ServicesAmpara

Mobile: +94 773 552 612Fax: +94 63 222 4487

Declaration of interest:None.
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Conflict of interest: None Declared

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