Patients Lives, Pharma Profits and Debatable Views

India’s Supreme Court has ruled against Big Pharma and for the country’s generic drug companies. But who’s the big winner in the end? But  the verdict is about much more than leukemia patients in India. It’s about India’s ability to legally continue to uphold its reputation as “the pharmacy to the third world.”


When the Swiss pharmaceutical firm Novartis lost its battle in India’s highest court on April 1, it was hailed as a major victory in India. The Indian Supreme Court rejected a plea by Novartis for patent protection for the drug Gleevec, which has been called a “miracle drug” for patients with some forms of leukemia. Now, Indian companies are free to make and distribute low-cost versions of the drug to the 300,000-some Indian patients currently using Gleevec. “It is a very happy day for us. Now we can cater to all cancer patients,” said Kiran Hukku of Cancer Patients Aid Association, which led the case against Novartis.
But the verdict is about much more than leukemia patients in India. It’s about India’s ability to legally continue to uphold its reputation as “the pharmacy to the third world.” Over the last decade, Indian pharmaceutical companies have pioneered the method of making cheap drugs by copy-catting brand-name medications when they go out of patent for everything from HIV to malaria. These drugs are used widely in India, where tens of millions of people still live on less than two dollars a day and cannot afford basic health care costs. It’s estimated that less than 10 per cent of drugs sold in India are under patent. That number can be partly accounted for by the country’s thriving business in counterfeit drugs, which makes up between 8 and 25 per cent of India’s drug market. But Indian drug makers also export about $10 billion worth of generic medicine every year. That means tens of millions of people across the developing world have come to rely on India’s cheap drugs.
Essentially, the battle between Indian and multinational pharmaceutical companies boils down to a fundamental disagreement about the definition and the ethics of innovation. India’s pharmaceutical companies have a very different business model than that of the research-focused big international pharma companies. Firms like Switzerland’s Novartis and America’s Pfizer  which is the world’s largest pharmaceutical company  often spend decades and billions of dollars developing a single medication. They say they need patent protection on their drugs in order to support the high research costs that come with innovation. Indian companies do not invest in research and development on the same scale. Rather, they wait until successful drugs come off patent, and then make copycat versions to sell at a fraction of the cost across the developing world. Indian generic manufacturers sell their version of Gleevec for about $175 a month; the brand-name medication costs patients in India $1,900 a month, although Novartis has a support program that has provided over $1.7 billion worth of Gleevec, free of cost, to Indian patients since 2002.
To U.S. pharma companies, the divide seems stark: Indian companies are simply stealing and repackaging their intellectual property. Yet the view is not the same in India. There, they take the moral high ground, arguing that the long-term costs of drug production become irrelevant if they are not an option for millions of patients in the developing world. After the Novartis decision, an editorial in the Indian newspaper ‘The Hindu’ declared, “The decision affirms the idea that a patent regime loses its social relevance when a drug is priced beyond the reach of the vast majority of a country’s people.” Popular sentiment against U.S. and multinational pharma companies, and support for domestic generic companies, remains strong.
Take Cipla, the country’s most successful generics company. In 2001, Cipla made world headlines by offering to sell a generic version of a triple cocktail of antiretroviral drugs to HIV-positive patients in developing countries for $350 a year, per patient. The cost was radically lower: in the West, the cocktail cost between $10,000 and $15,000 a year, per patient. Today, some 40 per cent of HIV/AIDS patients undergoing antiretroviral therapy worldwide take Cipla drugs. Cipla became known as the pharma company that cares. Its chairman and managing director, Yusuf Hamied, has been portrayed as a kind of Indian Robin Hood. In fact, he became a source of national pride in India. Hamied was awarded the Indian Government’s highest honor, the Padma Bhushan in 2005. In an interview with Forbes Asia, Hamied claimed that he has done more humanitarian work than Bill Gates and Warren Buffet.
Last year, Cipla announced that it was slashing the prices on its cancer drugs by 75 per cent, to make them not only affordable in India, but across sub-SaharanAfrica and in other low-income regions. “We had taken the lead to provide affordable medicine for AIDS, and I think the time has now come — 10 years later  when we do a similar thing for cancer,” Hamied told the Wall Street Journal. Not incidentally, Hamied is also one of the richest men in India. Last year, Forbes magazine declared that the ten richest tycoons who made their fortunes through generic drug manufacturing were worth a combined total of $25.7 billion. “India’s Pharma Kings,” the magazine dubbed them. Generic drugs may mean terrible business for multinational pharmaceutical companies, but clearly they have been a boon to India.
The sub-continent has been a frustrating market for big pharma. When India joined the World Trade Organization in 1995, the country was required to begin offering process patents on chemical compounds. However, it wasn’t for another decade that India amended its patent protection act to recognise actual pharmaceutical products. When it did, pharmaceutical firms like Pfizer and Novartis streamed in. They had high hopes: India’s economy was growing at 6 per cent a year, and it was an essentially untapped healthcare market of 1.2 billion people.
But when India amended its patent law, it also added a provision that does not protect new forms of a known substance unless it results in “increased efficacy.” This clause was intended to prevent the “evergreening” of drugs, the process of prolonging the life of a patent by making incremental or minor changes, such as changing the dosage or subtly altering the formula. India also sets a higher bar for patent approval than do many countries. In the Novartis case, advocates for low-cost medications argued that the company had not made fundamental changes to Gleevec. And on Monday, India’s Supreme Court agreed, ruling that Novartis’s Gleevec had failed “in both the tests of invention and patentability.”
For multinational pharmaceutical companies, the ruling was a major blow. Both Pfizer and the German multinational Bayer are already appealing decisions in Indian courts which have ruled that generic drug manufacturers can begin making their cancer drugs. Even if they lose these cases, though, neither company is likely to pull out of India altogether. Last year, Pfizer India saw revenues of $185 million.
Here in the United States, the industry group Pharmaceutical Research and Manufacturers of America called the decision “yet another example of the deteriorating innovation environment in India.” The Global Intellectual Property Center (GIPC) at the U.S. Chamber of Commerce, echoed that overall criticism: “Unfortunately, this high court decision is a symptom of a much larger problem in inadequate protection of intellectual property rights in India.” GPIC also noted that its recently released study comparing IP environments across the globe had found that that India “consistently ranked last among nearly every indicator.”
India has disappointed big pharma companies on every front. Not only is its economy undergoing a dramatic slowdown, but the country’s intellectual property and regulatory environment is not conducive to business, they claim  and its crop of fast-growing, successful generics companies means increased competition on all fronts. Because lobbying is illegal in India and pharmaceutical companies can only do so much, the U.S. Government has taken up a position as lead advocate for improving India’s intellectual property environment. For the most part, it does so in an informal way, as with most issues. The U.S. Trade Representative’s office said it was reviewing the Supreme Court’s order on Novartis.
After the ruling against Novartis, the company suggested that it may begin to pull out of research and development in India. But that’s unlikely. The possibility of great growth still beckons. According to the consulting firm Pricewaterhouse Coopers, the country’s pharmaceutical sector isexpected to grow to at least $50 billion in sales by 2020, from close to $19 billion in 2009. But that same report acknowledges that Indian generics companies are capable of taking a chunk of that wealth. Something like $70 billion worth of drugs will go off patent in the United States over the next three years, the report says, and India will be well-positioned to take a substantial share of the resulting new generics markets. Which means we’re likely to see a lot more frustrated multinational pharmaceutical companies pounding at the doors of the Indian justice system in years to come.
(This article appeared originally under the heading ‘Patently Reasonable’,)

Indian Pharma Has No Incentive To Innovate


“No one expected, when the first major clinical trial started on Glivec in 2000, that the patients would live much beyond a couple of years. Yet, seven years later, 86 per cent of them were still alive, and 82 per cent of them had achieved a complete response to the medicine. This breakthrough treatment for chronic myeloid leukemia is just one example of how innovation-based pharmaceutical companies continue to research and discover new therapies.
The decision by the Indian Supreme Court denying a patent to Glivec, the Novartis breakthrough medicine,discourages innovative drug discovery essential to advancing medical science for patients in need of new treatments.
The primary concern of this case was with India’s growing non-recognition of intellectual property rights that sustain research and development for innovative medicines. As a leader in both innovative and generic medicines, Novartis strongly supports the contribution of generics to improving public health once drug patents expire but generics alone do not guarantee access to medications.
In India, the Novartis patient access programme for Glivec is one of the most far-reaching programmes ever conceived. We have been providing Glivec free of charge to 95 per cent of the patients prescribed the drug and the balance 5 per cent are on a very generous co-pay programme. In fact, since Novartis began the access programme for Glivec in 2002, we have provided Glivec valued at more than $1.7 billion completely free to patients in India.
The hidden harm in this decision to deny a patent to Glivec is that it offers no incentive to India’s pharmaceutical companies to become innovators themselves.
The immense talents in India’s pharmaceutical companies should be focused on R&D of medicines that will help the people and the economy of India that go far beyond simply copying others’ inventions. Without patents there will be few new medicines and without new medicines there will be no new generics.
It is time for India’s own pharmaceutical companies to become creators and discoverers of medicines, and for the Indian Government to protect innovation.
Ranjit Shahani ( Vice-Chairman and Managing Director of Novartis India Limited)
Rediff. com


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