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DBL%20Hendrix%20small.png College chemistry, 1983

Derek Lowe The 2002 Model

Dbl%20new%20portrait%20B%26W.png After 10 years of blogging. . .

Derek Lowe, an Arkansan by birth, got his BA from Hendrix College and his PhD in organic chemistry from Duke before spending time in Germany on a Humboldt Fellowship on his post-doc. He's worked for several major pharmaceutical companies since 1989 on drug discovery projects against schizophrenia, Alzheimer's, diabetes, osteoporosis and other diseases. To contact Derek email him directly: derekb.lowe@gmail.com Twitter: Dereklowe

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May 7, 2007

Brazil Raises The Pirate Flag

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Posted by Derek

Back in 2005, the government of Brazil threatened to break the patent on Abbott's HIV medication Kaletra if the price didn't come down (see here and here). But after a lot of arm-wrestling, a deal was reached. Now it's Merck's turn, with their efavirenz, and this time things went all the way: on Friday, Brazil's president issued a compulsory license to produce the drug outside Merck's patent.

My problem with this, other than the obvious problem I have with expropriation of someone else's property, is that Brazil is trying to have things both ways. The government spends much of its time talking about how the country is an emerging power, with the 12th-largest economy in the world, huge natural resources, its own successful aircraft industry and space program, and so on. But when it comes time to pay for HIV medications, which are important both medically and politically, suddenly they're a poor third-world country being exploited by the evil multinational drugmakers. A look back at the second blog link above, with its quotes from Brazil's Minister of Health on how nationalizing drug patents would help the country's industry, shows that this issue probably has more to do with the first worldview than the second one.

During the Kaletra dispute, I asked a question:

I've known some pretty good Brazilian scientists, but the country isn't up to being able to discover and develop its own new ones. (Very few countries are; you can count them on your fingers.) So I've saved my usual justification for last: if Brazil decides to grab an HIV medication that other people discovered, tested, and won approval for, who's going to make the next one for them?

And now Merck is basically asking Brazil the same thing:

"Research and development-based pharmaceutical companies like Merck simply cannot sustain a situation in which the developed countries alone are expected to bear the cost for essential drugs in both least-developed countries and emerging markets. As such, we believe it is essential to price our medicines according to a country's level of development and HIV burden, thereby ensuring equitable access as well as our ability to invest in future innovative medicines. As the world's 12th largest economy, Brazil has a greater capacity to pay for HIV medicines than countries that are poorer or harder hit by the disease.

This decision by the Government of Brazil will have a negative impact on Brazil's reputation as an industrialized country seeking to attract inward investment, and thus its ability to build world-class research and development."

It should have, anyway. Look, intellectual property law is not pretty, and doesn't give anyone a warm feeling. It's not meant to. But the alternative Jolly-Roger world is even worse, and anything that takes us toward that is a bad move.

Comments (44) + TrackBacks (0) | Category: Drug Prices | Infectious Diseases | Patents and IP


COMMENTS

1. Steakandale on May 7, 2007 10:22 AM writes...

Why can't this be looked at as an illustration of the free market? Merck offers Brazil a price, Brazil thinks it is too high, so it will go for the competition (such as importing it from India).

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2. ChE on May 7, 2007 10:51 AM writes...

It's not a free market. The cost and value of a drug is the discovery and development process, not the actual cost of manufacturing a dose. That intellectual property was stolen.

The "competition" that Brazil has decided to use as akin to saying that a car chop shop is competing with a car dealer. Of course the prices at the chop shop are lower, but it's because of theft.

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3. Hap on May 7, 2007 10:58 AM writes...

Because items with large fixed costs would likely not be developed at all if patents didn't exist or were not enforced, or they would be developed as trade secrets in which the people that developed them would have a monopoly (because no one else could reproduce it) - the trade secret model seems hard to reconcile with safety issues, though, so that drugs would be hard to develop.

The free market isn't totally free - people put rules to constrain everyone's behavior (to forestall worse impingements).

I just wonder how Brazil intends to secure their inventions when the time comes - if you copy others' inventions when convenient, no one will really see a reason not to do it to you in turn. Their military probably isn't big enough to intimidate people who might do it to them. Jump starting your business by hosing prospective customers in a way they will find hard to forget while leaving an opening for those who come after you to take your market - that's a brilliant strategy...

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4. SNP on May 7, 2007 10:59 AM writes...

I'm reminded of a thought I had in connection with your "For people who remember the 1980s, all this still feels strange..." comment about Maraviroc a few days ago: if you had told people in 1987 that in 20 years the biggest villains in the AIDS world would be the makers of treatments, they would have thought you were nuts. Surely the world would pony up any amount of money to reward the people who saved us from the dread HIV!

Why can't this be looked at as an illustration of the free market?

It is, of course. The point of intellectual property law is that in a truly free market no one would be crazy enough to sink billions into R&D for any easily copyable product.

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5. SNP on May 7, 2007 11:21 AM writes...

On a related note, the New York Times op-ed today comparing patenting yoga positions to pharmaceutical patents is far and away the stupidest, most ignorant thing I have ever read on the subject. Including Slashdot discussions.

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6. MTK on May 7, 2007 11:40 AM writes...

Free trade does not mean it's a free for all. We all understand that "free speech" does not mean you have the right to say "Fire!" in a crowded movie house. Same thing here. Free trade means that everyone has the right to compete economically under the same set of principles, it does not mean you can do whatever you want.

Off-topic rhetorical question: What was the free speech analogy before the invention of movies or movie houses?

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7. ChE on May 7, 2007 11:46 AM writes...

MTK,
Before movies, it was play houses. The phrase about shouting fire in a crowded theater came from a supreme court case in 1919.

http://en.wikipedia.org/wiki/Shouting_fire_in_a_crowded_theater

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8. tom bartlett on May 7, 2007 12:05 PM writes...

"On a related note, the New York Times op-ed today comparing patenting yoga positions to pharmaceutical patents"

That's a new twist.....

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9. eugene on May 7, 2007 12:12 PM writes...

"On a related note, the New York Times op-ed today comparing patenting yoga positions to pharmaceutical patents is far and away the stupidest, most ignorant thing I have ever read on the subject."

SNP, it's very cruel of you to say something as juicy as that and not give us a link... Unless it's not web content?

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10. TFox on May 7, 2007 12:37 PM writes...

Uh, Brazil isn't "breaking the patent", they are issuing a compulsory license. This isn't piracy: they *are* the government, they make the laws, they are responsible for delineating the borders of the social contracts we call "property". You can argue that this compulsory license is a poor choice from a public policy perspective, but if you don't treat the government with respect, you'll have a tough time getting them to listen.

On a more practical level, Merck could threaten to close large Brazilian R&D sites. If they have any. If they don't, then no wonder the only weapon they have is the indignant press release.

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11. Sigivald on May 7, 2007 1:03 PM writes...

MYK: Also, libel is a long-standing exception to "free speech" protections.

It's never been protected speech to libel someone, after all.

TFox: Making laws that break treaties Brazil has signed is not what one would normally consider acceptable merely because they're a government.

I can and will call it "piracy", just as I would if a state said that ships carrying its flag "were allowed to" attack and seize or rob other ships absent a state of war or regardless of flag.

"Respect" is something earned, not demanded... except by tyrants, who won't respect you in return in any case. "Give us a license for free or we'll steal it" is not respectable in any case. Act like a pirate, get treated like one.

(Brazil is a signatory of the Paris Convention, which does not seem to allow for "compulsory licenses".)

"But the local government said it was okay!" does not make it not piracy, in either case.

(Nor is "oh, they're just issuing a compulsory license" an out.

The state could say "oh, it's not stealing your property. It's nationalisation! Or it's a compulsory donation!" ... but it's still theft there, too. Renaming the action doesn't change its nature.

"Because we can" (to riff off of "the only weapon they have...") is not a justification - it's simply an admission of piracy.)

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12. Still Scared of Dinosaurs on May 7, 2007 1:07 PM writes...

The point about Brazil alternating its image to suit its interest is a good one, but even in the case of more uniformly Third World nations there could be costs they may not anticipate.
One thing that comes to mind from the clinical trials world is that countries that make themselves unfriendly to pharma are probably going to be less attractive places to have sites in big global trials. This probably wouldn't be a net negative financially in itself, and certainly most of us aren't going to risk blowing our accrual timelines in sympathy with Merck. But to Derek's point that there are very few countries with the public and private infrastructure to support drug development it's important to note that, while not exactly easy, it's as least easier to create a culture of good clinical site management outside the US/EU. You can start with one good hospital, which even many of the poorest countries in the world have.
Participation in these trials can be an important source of money, experience, and credibility for the participating MDs and institutions, and I wonder how much more it would take before some of us start hearing, "We're not supposed to use sites in Brazil unless we have to."
I hate to think along these lines but sometimes all it takes is one high muckamuck with the right (or wrong?) job to make a decision like this. I also wonder, if this thought process were to take hold, how many other aspect of the pharma business model would also be affected. Anybody think Merck is planning on building factories in Brazil anytime soon?
Of course maybe the solution would be for Brazil to offer tax breaks on new facilities in lieu of royalties and everyone would be happy.
Wouldn't they?

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13. Hap on May 7, 2007 1:22 PM writes...

It doesn't seem like it's in Brazil's long-term interest to supplant trade with force - if they figure that using force or implied force to get their way in negotiation will be an effective strategy, they may have to discuss that strategy with the Indians and Chinese, who outnumber them >4:1 and have better militaries, to boot. When force supplants trade, the country with the biggest army wins. Brazil neither has the largest army nor the prospect of getting it - so it seems like a mistake to start a fight on whose terms they have no chance of winning. in addition, those countries also have better tech, so the odds do not improve.

I think they hope that they can take what they need from whichever power is dominant at the time (and that they won't have much to take in their turn) - as long as no one pushes the fight, they can get what they want because they don't figure that companies will give up selling to more lucrative markets to avoid selling to them, and they hope that frustration with pharmaceutical companies will prevent those companies from threats to drugs directed at them. It will work until someone more ruthless than they finds that Brazil has something they want.

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14. Analytical Chemist on May 7, 2007 1:23 PM writes...

TFox-

Compulsory licences are "free market" like the mafia going to a car dealership and saying, "Nice car. I'll give you $100 for it. It would be a shame if anything happened to your dealership..."

It's really coersion on that level that we accept to an amazing degree. In fact, the WTO accepts it only for great medical need, which I dispute in this case. If we were talking about wheat, oil, steel, or cars, the US government wouldn't put up with it, but we walk on egg shells about drugs in general and AIDS drugs in specific. These emerging nations got into the WTO by (in part) enacting IP laws to ensure that they would play fair. This is taking one big step back.

By the way, Merck has another recourse, too. They could, as Abbott recently threatened in Thailand, stop registering their drugs in Brazil. It's in noone's interest for it to get that ugly, though.

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15. Analytical Chemist on May 7, 2007 1:30 PM writes...

Here's another thought in the general theme of "taking my ball and going home". Brazil, Thailand, and several other SE Asian contries that are very hot and humid have recently been pushing a more rigorous standard of registration stability studies at 30C/75%RH, claiming to fall into a new "Zone 4B" climate zone (rather than the standard ICH Zone 4 of 30C/65%RH reference conditions). This adds no small expense to registration stability studies. Why should Merck and Abbott do this extra work for them if Brazil and Thailand are just going to turn around and try and screw them out of their IP? this falls into the category of unintended consequences. Ultimately, I can't see this happening--Merck is far to ethical to hurt the patients of Brazil, but I could see this causing delays in filing in Brazil as such testing is deprioritized due to pragmatic market drivers.

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16. Clark Kent on May 7, 2007 2:10 PM writes...

How is this any different than what Canada does? Canada sets the price for a drug and the company is forced to accept it. Brazil is just setting the price at zero.

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17. Analytical Chemist on May 7, 2007 2:57 PM writes...

Good point, Clark Kent. I don't approve of price controls in Canada either. With that said, Canadian reimportation is really importation of a coercive price control. And if you want to control prices in the US, this is the most gutless way to do it.

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18. SynChem on May 7, 2007 3:07 PM writes...

Clark Kent,

Please listen to yourself one more time. With all due respect, I've never heard a dumber statement than post 16, to the point of being comical.

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19. Derek on May 7, 2007 4:37 PM writes...

Re Canadian Price Controls: The Canadian equivalent of compulsory licensing vanished years ago. Canada does not set drug prices, which are set by the companies themselves. In over 15 years the Patented Medicines Review Board has existed they have only rejected 4 prices proposed by the manufacturers themselves. What they have is price monitoring and pricing guidelines:

* Prices must not exceed the highest Canadian price of existing drugs used to treat the same disease (for the "me-toos" out there).

* For "breakthrough" drugs, which are unique and have no competitors, prices must be no higher than the median of the price for the same drug charged in seven other countries: Britain, France, Germany, Italy, Sweden, Switzerland and the United States.

* Over time, prices cannot be increased beyond the general rate of inflation, as reflected in Canada's Consumer Price Index.

Hardly "forced pricing".


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20. Anonymous on May 7, 2007 4:43 PM writes...

It's very very very alarming that when we are talking about patents and pharmaceutical industry, military power was mentioned more than once. But at the same time it's very telling of the global situation we find ourselves in right now when the first thing that pops to mind is "but we can blow them to pieces if we have to..."

The arguement that this translates into a loss of potential profit is silly when there would not be any profit at all. The reason this is being implemented is because nobody would buy the drug in the first place. So exactly where is Merck losing money?

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21. MTK on May 7, 2007 4:59 PM writes...

Merck could easily lose money, if some of that drug made it's way out of Brazil or patients in other countries go to Brazil.

Beyond money, I'm always concerned when "the law" becomes lawless, because that just breeds, well, lawlessness. This is the type of situation which will simply invite people to make counterfeit drugs. Then people will be really hurt.

An article in yesterday's NYT about diethylene glycol being used in counterfeit glycerin that eventually made it's way into human medicines should scare the bejesus out of everyone.

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22. Hap on May 7, 2007 5:03 PM writes...

I didn't cite military force as an option to counter Brazil's - but I believe that that is the implicit threat when a country behaves as Brazil has done (give us the right to use your invention or we will take it). There is no presumption that anyone will behave violently in this case, but once the use of implicit (or explicit) force as a method to attain ecomomic goals is a fact of life, eventually it will no longer be implicit. As has been said elsewhere, the use of force to attain economic goals is a recipe for unending war, and one that trade is supposed to forestall.

Brazil likely wants to negate the patent to make Merck's drug without having to make the investments they did, which means Brazil's industry can make it more cheaply than Merck. There is no guarantee that the drugs will remain in Brazil - if the override of the patent is to support Brazilian industry, Brazil will produce a lot for export, and that will impinge on Merck's profits.

I don't agree with Ayn Rand so much, but I wonder if someone summoned the characters from Atlas Shrugged, just for giggles...

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23. Hap on May 7, 2007 5:06 PM writes...

MTK - Diethylene glycol? I thought that the use of diethylene glycol in a cough remedy, causing lots of children to die in agony, was the genesis of the FDA as much. I guess we really do refuse to learn from history...

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24. Anonymous on May 7, 2007 5:18 PM writes...

The argument becomes a lot easier if all of a suddent we add the "what if they start selling it to other countries". But unless we know otherwise, this is still about saving lives without losing forgone profits for a company like Merck. If implemented properly and carefully, the drugs would only be sold to those who cannot afford it and would not otherwise buy them.

I think most everyone writing in does not fully grasp the concept of someone being sick and not buying the drugs/medicine they need. It's a very real scenario in a lot of places. People living in richer countries almost never have to face that possibility - much less those who are writing into the blog.

So we automatically assume "if try really need it, they will find the money to pay for it." That's just not the case at all with a lot of people around the world. Try as they might, there's no magic pot of money.

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25. befuddled on May 7, 2007 6:42 PM writes...

I'm surprised at how uniformly, almost instinctively negative toward Brazil the responses have been. Personally, I don't have a firm opinion on whether Brazil or Merck is being unreasonable about the terms of this negotiation, but I see no reason why Brazil shouldn't be able to bargain on behalf of its citizens. And the case of a deadly disease which mutates so rapidly that *all* available therapies need to be available is a pretty good case for compulsory licensing ala the WTO.

I'll grant that Brazil's leadership is being hypocritical about its status as both an emerging power *and* a developing country requiring cut-rate drugs. But why make such a big deal over the grandstanding of some politicians? It seems like a fairly universal phenomenon.

Incidentally, you can find the patents-n-yoga piece at the IHT here: http://www.iht.com/articles/2007/05/07/opinion/edmehta.php
My impression was that the author was objecting to a IP regime where ancient yoga positions could be patented at the same time that poor people in developing countries find patented drugs priced out of their reach. It's not a policy prescription, but I think it's a reasonable point even if you agree with drug patents generally (as I do).

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26. befuddled on May 7, 2007 6:45 PM writes...

Oh, and surely, as in the case of software copyright infringement, all the "pirate" language is a little overblown, no?

But let me know as soon as Lula keelhauls some pharma executives.

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27. Anonymous on May 7, 2007 7:28 PM writes...

Hap, exactly right. It's still happening, and not surprisingly, the source is traced to China, a country which doesn't exactly have a great track record in terms of respect for IP, copyright, or other international laws. Like I said, when the law is lawless, it breeds lawlessness. Here's the link to the article. http://www.nytimes.com/2007/05/06/world/americas/06poison.html

And Anon, I believe that I and others are not trying to defend Merck or its profits at the expense of the sick. Quite the opposite. By allowing some profit, we are in fact trying to ensure that the sick get the medicines they need now and in the future. To be honest, if a company were allowed to make generic Efavirenz in Brazil, I really question how much would make it to the poor anyway.

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28. SNP on May 7, 2007 7:31 PM writes...

The reason this is being implemented is because nobody would buy the drug in the first place. So exactly where is Merck losing money?...I think most everyone writing in does not fully grasp the concept of someone being sick and not buying the drugs/medicine they need.

You're completely misunderstanding the situation. Brazil isn't Zaire -- they're buying the stuff from Merck now. Breaking patents is legal in case of an emergency, but deciding you suddenly want to pay 40% less doesn't constitute an emergency.

That was Derek's point, that Brazil is a high-tech power when they want to be, but all of a sudden they're playing the penniless basket case card.

SNP, it's very cruel of you to say something as juicy as that and not give us a link...

I don't like to link subscription-required content, but here you go. Seriously, can anyone single out one line of that as the most notably stupid? It's just a homogenous blob of idiocy.

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29. CET on May 7, 2007 7:46 PM writes...

Re #20, #24

Brazil is hardly Uganda or Somalia. Also, since their government dispenses AIDS treatment at no direct cost to patients, we are talking about the ability of a government (and not an especially impoverished one) to pay for the drugs.

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30. Anonymous on May 7, 2007 7:51 PM writes...

SNP... since when does a country have to reach the poverty level of Zaire to not be able to afford medicine? If you were to visit the country, then you'd have a clue what you're talking about. While on paper, Brazil may have the world's 12th biggest economy - there is an enormous gap between the rich and the poor who represent the masses. But in fact, many parts of the country resemble Zaire. Clearly, it appears as if the concept of unaffordable medicine is not within some people's grasp.


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31. ChemT on May 7, 2007 7:59 PM writes...

You're right. Brazil is neither Uganda nor Somalia. Those two countries don't have the option to do what Brazil is doing because they don't have the have infrastructure to make those drugs themselves. They are at the mercy of other countries to agree to give them a helping hand. However, it does not mean they are not facing a similar problem in that there are millions of patients that simply cannot afford to buy the necessary medicine.

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32. Clark Kent on May 7, 2007 10:43 PM writes...

You all missed the point of my argument. Once you believe it is ok for one government to set a price (or price ceiling as Derek points out in Canada), then why is it not ok for another government to set a price (price ceiling). Merck was not willing to accept Brazil's price, so Brazil did the next best thing, let someone else make the drug for the price they want. Either do away with all price controls, or all countries, including the US, should adopt them.

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33. Will on May 8, 2007 4:45 AM writes...

I don't think the issue is about profits, patients being able to afford this or that drug; it is about maintaining a system that has served the global population very well for the last few hundred years, Patents on novel ideas.
Should we descend into a free for all with regards to intellectual property then the ultimate losers will be those coutries which refuse to adhere to the IP laws. Would companies choose to licence a drug in a country where they knew it would be copied with impunity? I think not

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34. SNP on May 8, 2007 8:22 AM writes...

My impression was that the author was objecting to a IP regime where ancient yoga positions could be patented at the same time that poor people in developing countries find patented drugs priced out of their reach.

That would be a reasonable point if remotely true, which it isn't. Arguing that it's inappropriate for yoga instructors who have received the benefits of all this freely distributed knowledge to patent their new equipment would be a sane point, if the author had stopped there.

If you were to visit the country, then you'd have a clue what you're talking about. While on paper, Brazil may have the world's 12th biggest economy - there is an enormous gap between the rich and the poor who represent the masses. But in fact, many parts of the country resemble Zaire.

But that's hardly Merck's responsibility to solve! Not by what seems like common sense to me, and certainly not by law.

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35. ANe on May 8, 2007 3:45 PM writes...

Brazil's government might not be the only one trying a shortcut when public pressure increases. Remember the Tamiflu scare? http://opencrs.cdt.org/document/RL33159

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36. JSinger on May 8, 2007 4:54 PM writes...

Interesting coda on the Thailand situation, with Analytical Chemist's point about stability studies making an appearance.

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37. Brazillions of drugs on May 9, 2007 11:35 AM writes...

"But that's hardly Merck's responsibility to solve! Not by what seems like common sense to me, and certainly not by law."

SNP, but in that case, neither does Merck have the right to pass a judgment on whether Brazil can afford the drug or not.

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38. Hap on May 9, 2007 2:45 PM writes...

Merck is no more passing a judgment on Brazil than Worthington homeowners are passing a judgment on me for refusing to sell me a house for what I want to pay. They are not obligated to sell me a house for what I want to pay; they are not obligated to sell me a house at all.

Brazil has a choice of whether the drugs are worth what Merck charges or not. No judgment (with the overriding power it implies) is necessary, unless it is that of that pesky and unfortunate master called "a finite universe" - in that case, however, neither Merck nor Brazil are exempt from its judgement.

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39. Brazillions of drugs on May 9, 2007 3:11 PM writes...

Well, I understand that Merck is not obligated to sell anything to Brazil. That's just fine. But they do seem to be passing a judgment when they say:
"As the world's 12th largest economy, Brazil has a greater capacity to pay for HIV medicines than countries that are poorer or harder hit by the disease."
Who is Merck to judge that just because Brazil is the 12th largest country in the world, it would have enough money to pay for drugs? They are essentially saying, "WE think that Brazil has enough money to pay for this, so WE think that the price which we have set is perfectly all right". They have every right to set the price, but no right to appraise the financial state and paying capacity of Brazil, if only because a country's economics is quite complex and multifaceted.

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40. Hap on May 9, 2007 4:18 PM writes...

I thought that there are specific circumstances under which a country can make a patented drug (medical emergency) - if those circumstances existed, then Brazil wouldn't have to posture or argue they couldn't pay what Merck wants - they would simply start making the drug. Brazil could show its cards, and act accordingly.

I assume, however, that the current situation doesn't fit under those circumstances - that the treaties which cover internation patent law have fiscal standards by which to evaluate a country's ability to afford (or not) to licence or purchase a patented drug. By those standards, Merck can reasonably say that Brazil does have the money to pay them (otherwise they wouldn't be having this discussion). I think the implication as well is that Brazil touts its economic power in certain circumstances while touting its poverty in this one, which implies that their judgment of financial need is sort of flexible.

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41. nlvp on May 11, 2007 4:30 AM writes...

Bazillions -

But surely that's just the reverse side of the medal that says, "We're a country, we consider ourselves too poor to pay for this, so we're going to appropriate it in defiance of any rights you may think you have, because in our judgement, you have no rights in this matter"?

Brazil's big strength in this argument is that they know that once a drug is developed it's easy to copy. That applies to future drugs too.

In game-theory terms, we're heading fast towards a Nash equilibrium where it's not worth Merck's time to develop drugs they know will get ripped off, but it's in Brazil and other countries interests to convince them that they won't be ripped off otherwise the investment won't get made in the first place.

It's also a fairly good example of the free-rider problem. Provided not too many countries free ride in the appropriation of drug patents, the drugs will continue to be developed regardless, and they can continue to appropriate them for free. Just like a few dozen people riding the subway doesn't break the subway's finances either.

From Brazil's point of view, this is a convenient way to adopt a beggar-thy-neighbour economic and political policy that effects a transfer of wealth from developed countries and the businesses within them, that the developed countries can do nothing to prevent.

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42. Tomas on May 11, 2007 4:18 PM writes...

Derek: If you really believe in free trade, see http://en.wikipedia.org/wiki/Subsidies#Controversy
"One of the most controversial classes of subsidies, especially according to publications such as The Economist, are subsidies benefiting farmers in first-world countries. Charity institutions like Oxfam describe such subsidies as dumping millions of surplus commodities (like sugar) on world markets, destroying opportunities for farmers in developing and poor countries, especially in Africa. For example, the EU is currently spending €3.30 in subsidies to export sugar worth €1 Source: Oxfam briefing paper. These subsidies have remained in place even though many international accords have reduced other forms of subsidies or tariffs."
So..I think is unethical to force third world nations like Brazil to pay developed nations prices for the medications..while at the same time maintain subsidies benefiting farmers in first-world countries, for example.

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43. Derek Lowe on May 11, 2007 8:15 PM writes...

Tomas, I couldn't agree more about agricultural subsidies. I think the farm policies in the US, the EU, and Japan do a vast amount of harm while benefiting a shrinking group of comparatively wealthy farmers. I grew up in a totally agricultural area of Northeast Arkansas, by the way.

Brazil had substantial subsidies of its own in place for many years, but was more or less forced to abandon them in the 1990s, which has ended up working out very well (see this PDF from Stanford for more).

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44. Pippen on June 15, 2008 11:24 AM writes...

But what can Merck do if anything to safeguard it's intellectual property in the future from government's like Brasil?

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