I used to run an outbound medical tourism consultancy in China. Another NYT China hitpiece. Fact: This is not limited to China, it is a global phenomenon driven by the extreme profiteering of big pharma. I have personally seen medical systems in other countries leak legitimate medicines on the open market through fake 'patients' at hospitals. In addition: China has WAY more drug companies than any other country, and largely freer distribution. You can often purchase foreign medicine in China without issue. India has stood up to the status quo with its forward-looking stance on generics. European big-pharma has been extremely vicious in the deployment of propaganda throughout Asia to discourage generics and off-label, and has been assisted in this endeavor by the French state.
The movie mentioned in the report triggered a lot of discussions online. One question that troubled many Chinese was: Why Chinese need to smuggle cheap drugs instead of producing their own equivalent. The difference is obviously the IP cost of drugs owned by the big pharma because Chinese companies have the capability to produce the drugs. Then why China can not violate those IPs while India can? A popular explanation by some experts was: A US company had a disastrous accident in the 80's caused thousands of Indians death and blind. So US never put a pressure on India government to enforce the IP laws. But China is different. There's no way to have a scalable drug production without violate those drug IPs.
There's even a book about this unpunished tragedy, by Dominique Lapierre: "Five Past Midnight in Bhopal: The Epic Story of the World's Deadliest Industrial Disaster"
On the night of December 3, 1984, a cyanide cloud drifted over the streets of Bhopal, India, set loose by a leak in a nearby chemical plant. When the deadly fog lifted untold numbers of the city's residents--perhaps as many as 30,000, by some accounts--lay dead, while half a million others were injured. Dominique Lapierre, a French journalist and longtime champion of India's poor, joins with Spanish writer Javier Moro to recount the terrors of that night, about which the whole truth may never be known. The deaths are but one part of the authors' long, sometimes elaborate tale, which relates how the industrial conglomerate Union Carbide had come to build its vast chemical complex at Bhopal, one meant to be a glory of technology and, ironically, to save thousands of lives brought low by insect-wrought starvation. There are few villains but many heroes in the authors' account, which explores the margins at which good intentions conflict with the profit motive, at which cost-cutting omissions yield horrifically unintended consequences. It all makes for a thoughtful and disturbing book.
Bhopal incident. It's easily one of the worth industrial accidents in the world, and the then PM whisked Union Carbide's head out of India, instead of prosecuting his firm for the cleanup. That hasn't stopped the Americans from lobbying though.
China routinely violates tech IPs by Americans' own reporting; I'm surprised as to why they'd not do the same for drugs.
Here's very interesting difference of 2 cases about the statement "China violated many US IPs":
1.US IPs are violated in China.
2.Chinese government deliberately let Chinese companies violate US IPs.
They are not the same meaning. But media mislead Western audience to believe the second version by some tricky narrative and hide partial truth. The real situation is more complicated
Nothing happens in big business in China without a stamp of approval from Beijing. The reverse is true in the US, where Washington politicians need their report card signed by business interests, but it amounts to the same thing: there is no meaningful reason to distinguish between business elites and political elites in either system.
Yeah, India is very forward thinking about generics.[1]
Ranbaxy executives didn’t care, says Kathy Spreen, and made little effort to conceal it. In a conference call with a dozen company executives, one brushed aside her fears about the quality of the AIDS medicine Ranbaxy was supplying for Africa. “Who cares?” he said, according to Spreen. “It’s just blacks dying.”
There were consequences to this. There was an uproar over this in India at the time. Ranbaxy paid 500 million in settlement in felony charges related to drug safety. Finally, the company was acquired by Sun Pharma who fired most of the executives and staff.
India is also under pressure from the American state to cut down on generics; European pressure is apparently more in terms of supposed "human rights" violations. There have been rumors that India will buckle to this pressure, but I'm not sure when this will be. India's economy is currently not in a decent state, and if it becomes inevitable for IMF/WB to come 'rescue' it, this will almost certainly be on the agenda.
> European big-pharma has discouraged generics and off-label, and has been assisted in this endeavor by the French state.
Regarding France, I find odd (hypocrite?) that the French state is pushing against generics abroad, whereas locally the (state-run) social security system and health ministry are pushing for generics, because they are cheaper (and thus cheaper to refund).
Sadly, the Chinese government has less incentive to let the poor survive. It’s a cold, heartless form of population control. There are government officials who have come to the conclusion that delaying or not providing drugs for things like cancer will eventually help keep the country stable financially. In a country the size of China, they simply can’t afford to let everyone live to 85.
> Sadly, the Chinese government has less incentive to let the poor survive. It’s a cold, heartless form of population control. [...]
I have some friends who lived in Canada for a while. They said the Canadian medical system doesn't go all-out to treat people with cancer, which is probably just as well. Someone I knew (United States) just passed away from cancer. She spent 3 years getting treated, then died after a single day on hospice care. Medicare paid in full, I'm sure: that final operation was not a success, but the doctors were paid anyways.
Everyone dies eventually. American doctors are trained to try all the interventions they can possibly think of in a futile effort to prevent the inevitable. If my grandparents would have had to pay for their final months of interventions themselves, they certainly would have chosen to leave the funds in their estate. But since Medicare was paying they begrudgingly went along for the ride.
Denying medical treatment was used as a form of torture in the Mao years:
Liu Shaoqi was a Chinese revolutionary, politician, and theorist. He was Chairman of the NPC ... Originally groomed as Mao's successor, Liu antagonized him in the early 1960s before the .... He was denied medicine for his diabetes, by then a long-term illness, and for pneumonia, which he developed after his arrest.
It's just some shady semi-government-worker-semi-business-man who controls the important channel for extracting money, and usually they do not want poor people to live.
That's what you get if your governments give monopoly on making drugs to huge corporations. Patens and enormously costly "approvals" (rather than strict liability) are the root of the problem.
I don't think we'd have 99% of these novel clinical compounds if it weren't for patents.
As for approvals, I don't know why we have each country doing its own approvals, instead of international groups that individuals can choose whether they want to trust or not. Are Europeans sufficiently different than Chinese, Indians, Australians, Canadians, Germans or Americans to warrant independent safety approvals?
If they're using different metrics to process approvals, why? Shouldn't the same inputs result in the same outputs?
Well, considering the US avoided the thalidomide tragedy because they decided approval in Europe was t good enough, you’re unlikely to see a scenario where it gets approved simply because someone else approved it.
The real question is who will pay for testing drug safety and efficacy.
Take Auryxia which is literally ferric citrate. Its used by kidney patients to control phosphorus levels and boost iron. Why did it take so long to get tested and approved as a drug when the formula was "open source" for a long time? Well one company did the time and effort and suddenly it is considered a valuable drug. The value came from proving the safety and efficacy and someone has to be willing to fund it.
No offense but the article you referenced is misleading.
Sure, just the trial might cost that little if it’s an orphan disease, but it’s also ignoring all the other stuff that goes along with running a trial. Things like manufacturing, compliance, data analysis, etc.
When you look at the total cost of R&D for a drug, it’s typically 1/3 for discovery and 2/3 for development (clinical trials).
If your drug is used in any reasonable sized population, development is easily in the hundreds of millions of dollars.
This is totally false, as there are other parties which are interested in developing new drugs: academic researchers, insurance companies, and patients. The drug research is paid for by patients and insured as it stands now, but the FDA/pharma cartel monopolized drug development using patents and the hugely expensive approval process. Now, pharmas are interested in profitable drugs which don't as much cure the diseases but rather allow mainenance of chronic conditions for years and years. Actual effective cures are not a priority. Interests of insurers and patients are quute different: they would love quick, cheap, and effective cures. It's all about incentives.
> This is totally false, as there are other parties which are interested in developing new drugs: academic researchers, insurance companies, and patients.
Why would an insurance company be interested in developing new drugs? Health insurance companies don't lose money if you die.
How do you propose that academic researchers fund their work, all the way through the approval point?
> The drug research is paid for by patients and insured as it stands now, but the FDA/pharma cartel monopolized drug development using patents and the hugely expensive approval process.
Do you think the process is expensive because of the pharma companies, or do you think the pharma companies are the way they are because the process is expensive?
> Now, pharmas are interested in profitable drugs which don't as much cure the diseases but rather allow mainenance of chronic conditions for years and years. Actual effective cures are not a priority.
This is a thing people say, but it's not really true. It'd be great if all you had to do to create more cures was snap your fingers and change the incentive structure. But the fact of the matter is that cures are harder to create. Incremental improvements are easier. So you get more of them. Pharma companies do in fact still cure things when they can, see the recent HepC cure.
Is it? I remember seeing a paper in which they found no empirical evidence that patents actually help in medicine. I'd be interested to know if you have any information on it.
I'm not sure how that could be the case. I'm not familiar with that paper, but I would be curious to see its logic. It's hard to imagine that completely removing the financial incentive to create a thing would engender more of that thing.
Yeah, having dealt with Chinese vendors and mfgs for years that is a scary scenario. The whole culture of trust / fairness / honesty is very different from the west.
Dealt with our products being knocked off for years, wouldn’t want to buy cancer meds ever!
They proved they have no conscience with the Chinese baby formula scandal[1]: putting melamine in baby formula to save a little money, knowing that doing so would be poisoning infant children.
"A spokesman said the scale of the problem proved it was 'clearly not an isolated accident, [but] a large-scale intentional activity to deceive consumers for simple, basic, short-term profits.'"
I don't understand the complaint in that article? It seems to basically be that:
- Nestle made a baby formula
- They marketed it heavily to poor people in the third world.
- Poor people in the third world proceed to dilute the formula with more than the recommended amount of water to save money (and the article does not say that this was at Nestle's prompting), and as a result didn't feed their babies enough.
Maybe less than ideal and somewhat scummy? Sure, most advertising is like that really. Worse than literally selling poisonous baby formula? I don't see it.
I'd heard part of the problem was that Nestlé lied to mothers to make them think they needed it, gave them enough for free that their own breast-milk dried up making them dependent on formula to feed their child at which point many were stuck with an expense they couldn't actually afford leading to things like diluting the formula. Certainly not as bad as outright poisoning formula, but a shitty thing in general to poverty stricken areas who were more than capable of feeding their own babies for free before Nestlé took advantage of them to take what little those mothers had.
But this is nowhere near the same thing as the Chinese baby milk melamine scandal, as well as more localized fake baby milk powder scandals. In fact, people go to HK to buy so much baby milk powder that they had prevent export.
We are comparing a non defective product that couldn’t be used effectively by a certain populations to outright fraud.
I can see a product designer make the case that if millions are dying, then the product is defective in some way. The rules are different in two different places, but I can see how someone thinks these two cases are similar, both are about corporate greed, and the victims are just statistics. Is it murder if there is something wrong with the product, and you don't pull it? Many people out there believe that it is:
Well, one is against the law and the other is not and, in fact, couldn’t be without serious implications to personal freedom. One messes with the truthfulness of the information an informed consumer has available, the other simply relies on an uninformed consumer. These are not similar at all.
As an analogy, take sugary snacks. Say a snack has lots of sugar but the company claims it is sugar free anyways. In another case, a snack is truthful about its sugar content but the consumer lacks the education (or willpower) to care. Aren’t these completely different problems?
It depends on how innocent you think Nestle is. I can understand why someone would conclude that there is some "messing with the truthfulness" going on at Nestle. Both in the product design, and the marketing. It's why a lot of people call it a "scandal." I think this is less about laws for people who compare the two and more about morals. In one you have dozens dead, in the other, the claim is that millions died. Both are about corporations and profit and gaming the system and manipulating consumers, so in that sense, I think it's easy to make the case that they are extremely similar.
I think only a fringe call that a scandal since it doesn't involve outright deception. It all depends on whether you think someone should save people from themselves.
Sugar has probably killed more than millions, which has definitely been driven by corporate profits and gaming the system (substituting sugar for fat). But again, Coke Cola and Mars (and yes, Nestle) haven't been consider a scandal yet.
And they both clearly involve outright deception. The difference is probably just not as many babies dying. At least not yet, cokes aren't advertised as being healthier than breastfeeding for babies.
Formula is healthier than brestfeeding in some aspects (much less chance of an iron deficiency). In much of the world, there is no stigma to formula feeding a baby; I think it is mainly the USA that has gone on an aggressive breastfeeding campaign in the last few years.
the numbers are definitely worse. "millions" dead? that sounds pretty bad. Not sure how true that is. It certainly isn't clear. But the idea that a western corporation will do something like changing a product to save money, or not recalling a product knowing that someone out there will die... do you really need to be given examples of that?
Nestle marketed the formula heavily as a safe substitute for breast milk despite the fact they knew many Africans didn't have access to safe drinking water to make the formula, they sold it heavily discounted.
Mothers bought it and used it so their own breast milk dried up. Then when they couldn't afford enough of it as the baby grew and needed more, they were forced to ration the formula.
This is just one example. There is also fentanyl, knock off prescription medication, and I've even gotten fake sex toys from China.
The point is that stealing, lying, and poisoning Americans is part of Chinese culture. And what's worse is it appears that their state department is egging them on.
So sure, there are Americans that do greedy things and have externalities. The problem is, it's China's stated national policy.
Cutting corners to make items cheaper and make more money without govt regulation is capitalism and the end goal for the ruling American party (GOP). See their recent attacks on the EPA.
> poisoning Americans is part of Chinese culture .
WTF is wrong with you? Why are there humans on HN like you?
BTW the Chinese who poisoned their own countrymen in pursuit of profit were put to death, while the Americans who do the same to this day in Flint, Michigan and other places are still alive and they're still poisoning Americans. Is it American culture to poison your countrymen?
> The point is that stealing, lying, and poisoning Americans is part of Chinese culture.
That's a pretty repulsive sentiment, and it's rich too coming from an American like yourself. Not surprising that it garners plenty of upvotes on a cesspool like "Hacker" News.
I am referring to the "Chinese vendors and mfgs" in the parent comment, not the entire Chinese "race." I called them conscience-less.
In support of my view, I quoted the World Health Organization stating that these people knew what they were doing, and it was done intentionally on a large scale.
In your view, is the World Health Organization fond of writing "racist white supremcist[sic] drivel"?
How is it "racist" or "white supremacist" to express horror at injury and death of Chinese babies? If I were either of those slurs, I would be celebrating this scandal, not expressing horror at it.
There is a good chunk of the userbase that doesn't care to think about what the statement you're responding to sounds like, or that the spin that you read here might be part of a concerted effort to make a whole country look bad.
It's worthwhile to bring attention to that and it's good that you're doing so, but try to put it in a format that uses examples and sound reasoning. That way people might be more inclined to listen to it, as opposed to a fairly emotional argument that is also vaguely hostile to boot.
> consider the details of the Chinese infant formula scandal of 2008. Unscrupulous businessmen had discovered they could save money by greatly diluting their milk products, then adding a plastic chemical compound called melamine to raise the apparent protein content back to normal levels. Nearly 300,000 babies throughout China had suffered urinary problems, with many hundreds requiring lengthy hospitalization for kidney stones. Six died. A wave of popular outrage swept past the controlled media roadblocks and initial government excuses, and soon put enormous pressure on Chinese officials to take forceful action against the wrongdoers.
> China’s leaders may not be democratically elected, but they pay close attention to strong popular sentiment. Once pressed, they quickly launched a national police investigation which led to a series of arrests and uncovered evidence that this widespread system of food adulteration had been protected by bribe-taking government officials. Long prison sentences were freely handed out and a couple of the guiltiest culprits were eventually tried and executed for their role, measures that gradually assuaged popular anger. Indeed, the former head of the Chinese FDA had been executed for corruption in late 2007 under similar circumstances.
> In September 2004, Merck, one of America’s largest pharmaceutical companies, suddenly announced that it was voluntarily recalling Vioxx, its popular anti-pain medication widely used to treat arthritis-related ailments. This abrupt recall came just days after Merck discovered that a top medical journal was about to publish a massive study by an FDA investigator indicating that the drug in question greatly increased the risk of fatal heart attacks and strokes and had probably been responsible for at least 55,000 American deaths during the five years it had been on the market.
> Within weeks of the recall, journalists discovered that Merck had found strong evidence of the potentially fatal side-effects of this drug even before its initial 1999 introduction, but had ignored these worrisome indicators and avoided additional testing, while suppressing the concerns of its own scientists. Boosted by a television advertising budget averaging a hundred million dollars per year, Vioxx soon became one of Merck’s most lucrative products, generating over $2 billion in yearly revenue. Merck had also secretly ghostwritten dozens of the published research studies emphasizing the beneficial aspects of the drug and encouraging doctors to widely prescribe it, thus transforming science into marketing support. Twenty-five million Americans were eventually prescribed Vioxx as an aspirin-substitute thought to produce fewer complications.
> Although the Vioxx scandal certainly did generate several days of newspaper headlines and intermittently returned to the front pages as the resulting lawsuits gradually moved through our judicial system, the coverage still seemed scanty relative to the number of estimated fatalities, which matched America’s total losses in the Vietnam War. In fact, the media coverage often seemed considerably less than that later accorded to the Chinese infant food scandal, which had caused just a handful of deaths on the other side of the world.
Killing an old person 7 years before they would otherwise die is not as bad as killing an infant 78 years before it would otherwise die. But is it really less than 0.1% as bad?
I mean, western companies promoted powdered milk to developing countries which likely has indirectly killed a lot of babies. They also promoted smoking, pollution, petroleum, prescription narcotics and a lot of other things that have killed a lot of people including babies.
And this is what the Socisl Credit System is trying to solve.
It’s also interesting how saying Chinese people are so different is widely accepted on HN. Can you imagine if the same comment was made about Jewish people?
I do hear others say the Chinese are the Jews of the East.
And “having dealt with Jewish vendors and mfgs for years that is a scary scenario. The whole culture of trust / fairness / honesty is very different from the west.”
Yeah, having dealt with Chinese vendors and mfgs for years that is a scary scenario.
I've met contractors who did extensive work for businessmen in the US, who then turned around and told the contractor, "You want to be paid? Sue me!"
The whole culture of trust / fairness / honesty is very different from the west.
Is it really that different? There are some people who are good and some people who end up being opportunistic in evil ways. The more I learn about differences across cultures, the more I conclude that the differences are always ones of degree, and the differences are made more visible due to the cultural contrasts. That said, is there more rule of law and enforcement around IP issues in the west than in China? I suspect that's also true.
Dealt with our products being knocked off for years, wouldn’t want to buy cancer meds ever!
There are also people in the west who aren't above faking treatments for cancer.
Being Chinese myself, I can say the moral standard of normal Chinese are more bipolar than western world.
Some are incredibly kind and fair.
Some are incredibly immoral, who can be viewed as demon incarnations. See example like this: https://www.zhihu.com/question/53610601 (manufacture human monster slave to use as worker as fake beggar)
As time goes on, people adjust to the rule of law and societal standards. What happens in the west is that the "optics" are far better. Much of the corruption remains, however. Unfortunately, I think that's baked into reality and human nature.
The free press and independent justice system makes the difference.
Those can and do make a difference. No system is perfect, however. Chinese culture has an extensive heritage of moral philosophy. Despite that, it's still been shown that it's possible to overturn the social order there with massive consequences. The west certainly isn't above that sort of chaos. France and Germany, the largest economic powers of continental Europe, have that in their history. The US isn't entirely above this kind of chaos, either.
The press in the west also follows a propaganda model.
Justice systems in the west have been known to cooperate with the authorities in miscarriages of justice, particularly in wartime or when subject to near-wartime hysteria.
When it comes down to it, there is always a struggle between good and evil in all times and places. The really tricky part of it is this: The worst evils disguise themselves as movements of good and justice. People and movements should be judged by their actions. Ask: Who is committing violence against whom? Who abets or tacitly accepts bad actions? Who is willing to call out their own side and their own tribe when they do wrong?
The left/right political spectrum ceases to have meaning when you look at it that way. The Authoritarian/Anti-authoritarian spectrum and the tribalist/universalist spectrums hold much more value.
Google is not that corrupt yet, thank goodness. However, to respond to the idea in the other comment: That Chinese people, Chinese society, or Chinese culture is somehow the root cause, I think we should be calling out Baidu and the PLA in particular.
Oh, I totally believe those things would happen in the states if we didn’t have much better rule of law than China. It’s a corrupt government, but culture that it is the problem.
>Is it really that different? There are some people who are good and some people who end up being opportunistic in evil ways. The more I learn about differences across cultures, the more I conclude that the differences are always ones of degree, and the differences are made more visible due to the cultural contrasts.
Exactly. When you have a culture that more often accepts scams as necessary to succeed and another culture that shuns them, you will probably see disparities in the percentages of people in those cultures who are willing to scam. Ostracism is a powerful deterrent.
They are yuaigongwu and 51qiji. They have helped numerous patients in China. To be fair, they are mostly patient forums helping each other and most of the medicine for cancer can be purchased with discount in China. They are less expensive than the US but still expensive which is why some poorer patients are seeking alternatives/self made medicine.
This will be the normal state in India too if we buckle to US lobbying and capitalist pressure. There is extraordinary and continuous (every-day) compulsion on Indian diplomats, trade officials and politicians to keep expanding the scope of the Patents Act, reduce the scope of generics, and decrease the 'innovation threshold' of what can be patented so as to allow continuous ever-greening of drugs. I am not confident that the Indian government can withstand this in the long term.
I used to run an outbound medical tourism consultancy in China. Another NYT China hitpiece. Fact: This is not limited to China, it is a global phenomenon driven by the extreme profiteering of big pharma. I have personally seen medical systems in other countries leak legitimate medicines on the open market through fake 'patients' at hospitals. In addition: China has WAY more drug companies than any other country, and largely freer distribution. You can often purchase foreign medicine in China without issue. India has stood up to the status quo with its forward-looking stance on generics. European big-pharma has been extremely vicious in the deployment of propaganda throughout Asia to discourage generics and off-label, and has been assisted in this endeavor by the French state.
The movie mentioned in the report triggered a lot of discussions online. One question that troubled many Chinese was: Why Chinese need to smuggle cheap drugs instead of producing their own equivalent. The difference is obviously the IP cost of drugs owned by the big pharma because Chinese companies have the capability to produce the drugs. Then why China can not violate those IPs while India can? A popular explanation by some experts was: A US company had a disastrous accident in the 80's caused thousands of Indians death and blind. So US never put a pressure on India government to enforce the IP laws. But China is different. There's no way to have a scalable drug production without violate those drug IPs.
I don't know the explaination is accurate or not.
There's even a book about this unpunished tragedy, by Dominique Lapierre: "Five Past Midnight in Bhopal: The Epic Story of the World's Deadliest Industrial Disaster"
On the night of December 3, 1984, a cyanide cloud drifted over the streets of Bhopal, India, set loose by a leak in a nearby chemical plant. When the deadly fog lifted untold numbers of the city's residents--perhaps as many as 30,000, by some accounts--lay dead, while half a million others were injured. Dominique Lapierre, a French journalist and longtime champion of India's poor, joins with Spanish writer Javier Moro to recount the terrors of that night, about which the whole truth may never be known. The deaths are but one part of the authors' long, sometimes elaborate tale, which relates how the industrial conglomerate Union Carbide had come to build its vast chemical complex at Bhopal, one meant to be a glory of technology and, ironically, to save thousands of lives brought low by insect-wrought starvation. There are few villains but many heroes in the authors' account, which explores the margins at which good intentions conflict with the profit motive, at which cost-cutting omissions yield horrifically unintended consequences. It all makes for a thoughtful and disturbing book.
Bhopal incident. It's easily one of the worth industrial accidents in the world, and the then PM whisked Union Carbide's head out of India, instead of prosecuting his firm for the cleanup. That hasn't stopped the Americans from lobbying though.
China routinely violates tech IPs by Americans' own reporting; I'm surprised as to why they'd not do the same for drugs.
Here's very interesting difference of 2 cases about the statement "China violated many US IPs":
1.US IPs are violated in China. 2.Chinese government deliberately let Chinese companies violate US IPs.
They are not the same meaning. But media mislead Western audience to believe the second version by some tricky narrative and hide partial truth. The real situation is more complicated
Nothing happens in big business in China without a stamp of approval from Beijing. The reverse is true in the US, where Washington politicians need their report card signed by business interests, but it amounts to the same thing: there is no meaningful reason to distinguish between business elites and political elites in either system.
There was union carbide accident in the 1980's a tragedy.
Yeah, India is very forward thinking about generics.[1]
Ranbaxy executives didn’t care, says Kathy Spreen, and made little effort to conceal it. In a conference call with a dozen company executives, one brushed aside her fears about the quality of the AIDS medicine Ranbaxy was supplying for Africa. “Who cares?” he said, according to Spreen. “It’s just blacks dying.”
[1]https://blogs.sciencemag.org/pipeline/archives/2013/05/17/a_...
There were consequences to this. There was an uproar over this in India at the time. Ranbaxy paid 500 million in settlement in felony charges related to drug safety. Finally, the company was acquired by Sun Pharma who fired most of the executives and staff.
One of the worst companies I have ever had the pleasure of working with. Everything is just seemingly beneath them including their own jobs.
India is also under pressure from the American state to cut down on generics; European pressure is apparently more in terms of supposed "human rights" violations. There have been rumors that India will buckle to this pressure, but I'm not sure when this will be. India's economy is currently not in a decent state, and if it becomes inevitable for IMF/WB to come 'rescue' it, this will almost certainly be on the agenda.
> European big-pharma has discouraged generics and off-label, and has been assisted in this endeavor by the French state.
Regarding France, I find odd (hypocrite?) that the French state is pushing against generics abroad, whereas locally the (state-run) social security system and health ministry are pushing for generics, because they are cheaper (and thus cheaper to refund).
The article is about what happens in China. It does not claim the phenomenon is exclusive to China.
Sadly, the Chinese government has less incentive to let the poor survive. It’s a cold, heartless form of population control. There are government officials who have come to the conclusion that delaying or not providing drugs for things like cancer will eventually help keep the country stable financially. In a country the size of China, they simply can’t afford to let everyone live to 85.
> Sadly, the Chinese government has less incentive to let the poor survive. It’s a cold, heartless form of population control. [...]
I have some friends who lived in Canada for a while. They said the Canadian medical system doesn't go all-out to treat people with cancer, which is probably just as well. Someone I knew (United States) just passed away from cancer. She spent 3 years getting treated, then died after a single day on hospice care. Medicare paid in full, I'm sure: that final operation was not a success, but the doctors were paid anyways.
Everyone dies eventually. American doctors are trained to try all the interventions they can possibly think of in a futile effort to prevent the inevitable. If my grandparents would have had to pay for their final months of interventions themselves, they certainly would have chosen to leave the funds in their estate. But since Medicare was paying they begrudgingly went along for the ride.
Denying medical treatment was used as a form of torture in the Mao years:
Liu Shaoqi was a Chinese revolutionary, politician, and theorist. He was Chairman of the NPC ... Originally groomed as Mao's successor, Liu antagonized him in the early 1960s before the .... He was denied medicine for his diabetes, by then a long-term illness, and for pneumonia, which he developed after his arrest.
Its also used now. That's why many dissidents die from lack of medical care in Prison. https://www.nytimes.com/2017/07/10/world/asia/liu-xiaobo-med...
You probably watched too much Fox news. This is just a Chinese version of dallas buyers club.
That's a really damning statement of intent with no evidence whatsoever.
Healthcare is hard, Americans especially should get that.
cheaper medicine means cheaper bill for the social system, how can that be a bad thing?
They can.
It's just some shady semi-government-worker-semi-business-man who controls the important channel for extracting money, and usually they do not want poor people to live.
See for example: https://asia.nikkei.com/Business/Companies/China-s-Changshen...
Some companies produces fake vaccines and regulated the vaccine market to not allow imported vaccines.
That's what you get if your governments give monopoly on making drugs to huge corporations. Patens and enormously costly "approvals" (rather than strict liability) are the root of the problem.
I don't think we'd have 99% of these novel clinical compounds if it weren't for patents.
As for approvals, I don't know why we have each country doing its own approvals, instead of international groups that individuals can choose whether they want to trust or not. Are Europeans sufficiently different than Chinese, Indians, Australians, Canadians, Germans or Americans to warrant independent safety approvals?
If they're using different metrics to process approvals, why? Shouldn't the same inputs result in the same outputs?
If approvals were about science, one approval would be good enough worldwide.
In reality, approvals are also about politics.
Well, considering the US avoided the thalidomide tragedy because they decided approval in Europe was t good enough, you’re unlikely to see a scenario where it gets approved simply because someone else approved it.
The thalidomide tragedy didn't happen in France too, because of a new law adding stricter controls on drugs.
Why wouldn't these compounds evolve to be open source? Barriers to entry wouldn't be billions in R&D if every stepping stone was open sourced.
The real question is who will pay for testing drug safety and efficacy.
Take Auryxia which is literally ferric citrate. Its used by kidney patients to control phosphorus levels and boost iron. Why did it take so long to get tested and approved as a drug when the formula was "open source" for a long time? Well one company did the time and effort and suddenly it is considered a valuable drug. The value came from proving the safety and efficacy and someone has to be willing to fund it.
Drug tests are not inherently that expensive. FDA trials run about 1% of the cost of each new drug. https://www.jhsph.edu/news/news-releases/2018/cost-of-clinic...
The long line of failed drugs are the real issue.
No offense but the article you referenced is misleading.
Sure, just the trial might cost that little if it’s an orphan disease, but it’s also ignoring all the other stuff that goes along with running a trial. Things like manufacturing, compliance, data analysis, etc.
When you look at the total cost of R&D for a drug, it’s typically 1/3 for discovery and 2/3 for development (clinical trials).
If your drug is used in any reasonable sized population, development is easily in the hundreds of millions of dollars.
You are correct about the failure rates though.
...and what do you think you get if you don't do those things? The answer is no drugs at all.
This is totally false, as there are other parties which are interested in developing new drugs: academic researchers, insurance companies, and patients. The drug research is paid for by patients and insured as it stands now, but the FDA/pharma cartel monopolized drug development using patents and the hugely expensive approval process. Now, pharmas are interested in profitable drugs which don't as much cure the diseases but rather allow mainenance of chronic conditions for years and years. Actual effective cures are not a priority. Interests of insurers and patients are quute different: they would love quick, cheap, and effective cures. It's all about incentives.
> This is totally false, as there are other parties which are interested in developing new drugs: academic researchers, insurance companies, and patients.
Why would an insurance company be interested in developing new drugs? Health insurance companies don't lose money if you die.
How do you propose that academic researchers fund their work, all the way through the approval point?
> The drug research is paid for by patients and insured as it stands now, but the FDA/pharma cartel monopolized drug development using patents and the hugely expensive approval process.
Do you think the process is expensive because of the pharma companies, or do you think the pharma companies are the way they are because the process is expensive?
> Now, pharmas are interested in profitable drugs which don't as much cure the diseases but rather allow mainenance of chronic conditions for years and years. Actual effective cures are not a priority.
This is a thing people say, but it's not really true. It'd be great if all you had to do to create more cures was snap your fingers and change the incentive structure. But the fact of the matter is that cures are harder to create. Incremental improvements are easier. So you get more of them. Pharma companies do in fact still cure things when they can, see the recent HepC cure.
Is it? I remember seeing a paper in which they found no empirical evidence that patents actually help in medicine. I'd be interested to know if you have any information on it.
I'm not sure how that could be the case. I'm not familiar with that paper, but I would be curious to see its logic. It's hard to imagine that completely removing the financial incentive to create a thing would engender more of that thing.
What country has had success with using the strict liability approach?
>”You just hope the sellers have a conscience.”
Yeah, having dealt with Chinese vendors and mfgs for years that is a scary scenario. The whole culture of trust / fairness / honesty is very different from the west.
Dealt with our products being knocked off for years, wouldn’t want to buy cancer meds ever!
They proved they have no conscience with the Chinese baby formula scandal[1]: putting melamine in baby formula to save a little money, knowing that doing so would be poisoning infant children.
"A spokesman said the scale of the problem proved it was 'clearly not an isolated accident, [but] a large-scale intentional activity to deceive consumers for simple, basic, short-term profits.'"
[1] https://en.wikipedia.org/wiki/2008_Chinese_milk_scandal
Who is "they"?
This is a nation of almost 1.4 billion people.
There are more unarmed civilians (including children) murdered by US police every year than all deaths from the Chinese milk scandal combined.
Would that make it reasonable to state that "All US citizens have proved they have no conscience"?
In any case, the Chinese milk scandal pales in comparison to what Nestle did: https://www.businessinsider.com/nestles-infant-formula-scand...
Do you no longer buy Nestle?
> Who is "they"?
From the parent comment: "Chinese vendors and mfgs"
I don't understand the complaint in that article? It seems to basically be that:
- Nestle made a baby formula
- They marketed it heavily to poor people in the third world.
- Poor people in the third world proceed to dilute the formula with more than the recommended amount of water to save money (and the article does not say that this was at Nestle's prompting), and as a result didn't feed their babies enough.
Maybe less than ideal and somewhat scummy? Sure, most advertising is like that really. Worse than literally selling poisonous baby formula? I don't see it.
But perhaps I misunderstand the accusation.
I'd heard part of the problem was that Nestlé lied to mothers to make them think they needed it, gave them enough for free that their own breast-milk dried up making them dependent on formula to feed their child at which point many were stuck with an expense they couldn't actually afford leading to things like diluting the formula. Certainly not as bad as outright poisoning formula, but a shitty thing in general to poverty stricken areas who were more than capable of feeding their own babies for free before Nestlé took advantage of them to take what little those mothers had.
But this is nowhere near the same thing as the Chinese baby milk melamine scandal, as well as more localized fake baby milk powder scandals. In fact, people go to HK to buy so much baby milk powder that they had prevent export.
We are comparing a non defective product that couldn’t be used effectively by a certain populations to outright fraud.
I can see a product designer make the case that if millions are dying, then the product is defective in some way. The rules are different in two different places, but I can see how someone thinks these two cases are similar, both are about corporate greed, and the victims are just statistics. Is it murder if there is something wrong with the product, and you don't pull it? Many people out there believe that it is:
https://www.odwyerpr.com/story/public/5379/2015-09-18/gm-pay...
Well, one is against the law and the other is not and, in fact, couldn’t be without serious implications to personal freedom. One messes with the truthfulness of the information an informed consumer has available, the other simply relies on an uninformed consumer. These are not similar at all.
As an analogy, take sugary snacks. Say a snack has lots of sugar but the company claims it is sugar free anyways. In another case, a snack is truthful about its sugar content but the consumer lacks the education (or willpower) to care. Aren’t these completely different problems?
It depends on how innocent you think Nestle is. I can understand why someone would conclude that there is some "messing with the truthfulness" going on at Nestle. Both in the product design, and the marketing. It's why a lot of people call it a "scandal." I think this is less about laws for people who compare the two and more about morals. In one you have dozens dead, in the other, the claim is that millions died. Both are about corporations and profit and gaming the system and manipulating consumers, so in that sense, I think it's easy to make the case that they are extremely similar.
I think only a fringe call that a scandal since it doesn't involve outright deception. It all depends on whether you think someone should save people from themselves.
Sugar has probably killed more than millions, which has definitely been driven by corporate profits and gaming the system (substituting sugar for fat). But again, Coke Cola and Mars (and yes, Nestle) haven't been consider a scandal yet.
some would call sugar a scandal, probably with valid reasoning too:
https://www.huffpost.com/entry/sugar-harvard-scandal-nutriti...
And they both clearly involve outright deception. The difference is probably just not as many babies dying. At least not yet, cokes aren't advertised as being healthier than breastfeeding for babies.
Formula is healthier than brestfeeding in some aspects (much less chance of an iron deficiency). In much of the world, there is no stigma to formula feeding a baby; I think it is mainly the USA that has gone on an aggressive breastfeeding campaign in the last few years.
the numbers are definitely worse. "millions" dead? that sounds pretty bad. Not sure how true that is. It certainly isn't clear. But the idea that a western corporation will do something like changing a product to save money, or not recalling a product knowing that someone out there will die... do you really need to be given examples of that?
Millions died because mother's diluted the formula, against the instructions of the company. How is that Nestle's fault?
Nestle marketed the formula heavily as a safe substitute for breast milk despite the fact they knew many Africans didn't have access to safe drinking water to make the formula, they sold it heavily discounted.
Mothers bought it and used it so their own breast milk dried up. Then when they couldn't afford enough of it as the baby grew and needed more, they were forced to ration the formula.
Millions died.
This is just one example. There is also fentanyl, knock off prescription medication, and I've even gotten fake sex toys from China.
The point is that stealing, lying, and poisoning Americans is part of Chinese culture. And what's worse is it appears that their state department is egging them on.
So sure, there are Americans that do greedy things and have externalities. The problem is, it's China's stated national policy.
> stealing, lying, and poisoning Americans is part of Chinese culture.
National/racial smears are unacceptable here. If you use HN for nationalistic flamewar again we will ban you.
Cutting corners to make items cheaper and make more money without govt regulation is capitalism and the end goal for the ruling American party (GOP). See their recent attacks on the EPA.
> poisoning Americans is part of Chinese culture .
WTF is wrong with you? Why are there humans on HN like you?
BTW the Chinese who poisoned their own countrymen in pursuit of profit were put to death, while the Americans who do the same to this day in Flint, Michigan and other places are still alive and they're still poisoning Americans. Is it American culture to poison your countrymen?
Flint crisis is over.
I think you missed the point.
The Chinese melamine scandal is over too.
And yet I can't buy a tin of baby formula because it's all sold out instantly.
But not the lead crisis.
> The point is that stealing, lying, and poisoning Americans is part of Chinese culture.
That's a pretty repulsive sentiment, and it's rich too coming from an American like yourself. Not surprising that it garners plenty of upvotes on a cesspool like "Hacker" News.
> Not surprising that it garners plenty of upvotes on a cesspool like "Hacker" News.
Since it's both flagged (from user flags) and dead (from user downvotes), I don't think that comment is warranted.
How is this racist white supremcist drivel allows to stay on HN? We are 1 human race, there is no difference between skin color.
To call out an entire people as cruel and heartless is just so wrong!
I am referring to the "Chinese vendors and mfgs" in the parent comment, not the entire Chinese "race." I called them conscience-less.
In support of my view, I quoted the World Health Organization stating that these people knew what they were doing, and it was done intentionally on a large scale.
In your view, is the World Health Organization fond of writing "racist white supremcist[sic] drivel"?
How is it "racist" or "white supremacist" to express horror at injury and death of Chinese babies? If I were either of those slurs, I would be celebrating this scandal, not expressing horror at it.
There is a good chunk of the userbase that doesn't care to think about what the statement you're responding to sounds like, or that the spin that you read here might be part of a concerted effort to make a whole country look bad.
It's worthwhile to bring attention to that and it's good that you're doing so, but try to put it in a format that uses examples and sound reasoning. That way people might be more inclined to listen to it, as opposed to a fairly emotional argument that is also vaguely hostile to boot.
1 human race, but very different financially. That will lead to many different things.
When I saw a video[1] about Chinese gutter oil, I didn't believe something as repulsive could exist. I was wrong.
[1] https://www.youtube.com/watch?v=zrv78nG9R04
One just needs to read https://en.wikipedia.org/wiki/2008_Chinese_milk_scandal to see that some seemingly didn't even care if they killed babies...
https://www.unz.com/runz/chinese-melamine-and-american-vioxx...
> consider the details of the Chinese infant formula scandal of 2008. Unscrupulous businessmen had discovered they could save money by greatly diluting their milk products, then adding a plastic chemical compound called melamine to raise the apparent protein content back to normal levels. Nearly 300,000 babies throughout China had suffered urinary problems, with many hundreds requiring lengthy hospitalization for kidney stones. Six died. A wave of popular outrage swept past the controlled media roadblocks and initial government excuses, and soon put enormous pressure on Chinese officials to take forceful action against the wrongdoers.
> China’s leaders may not be democratically elected, but they pay close attention to strong popular sentiment. Once pressed, they quickly launched a national police investigation which led to a series of arrests and uncovered evidence that this widespread system of food adulteration had been protected by bribe-taking government officials. Long prison sentences were freely handed out and a couple of the guiltiest culprits were eventually tried and executed for their role, measures that gradually assuaged popular anger. Indeed, the former head of the Chinese FDA had been executed for corruption in late 2007 under similar circumstances.
> In September 2004, Merck, one of America’s largest pharmaceutical companies, suddenly announced that it was voluntarily recalling Vioxx, its popular anti-pain medication widely used to treat arthritis-related ailments. This abrupt recall came just days after Merck discovered that a top medical journal was about to publish a massive study by an FDA investigator indicating that the drug in question greatly increased the risk of fatal heart attacks and strokes and had probably been responsible for at least 55,000 American deaths during the five years it had been on the market.
> Within weeks of the recall, journalists discovered that Merck had found strong evidence of the potentially fatal side-effects of this drug even before its initial 1999 introduction, but had ignored these worrisome indicators and avoided additional testing, while suppressing the concerns of its own scientists. Boosted by a television advertising budget averaging a hundred million dollars per year, Vioxx soon became one of Merck’s most lucrative products, generating over $2 billion in yearly revenue. Merck had also secretly ghostwritten dozens of the published research studies emphasizing the beneficial aspects of the drug and encouraging doctors to widely prescribe it, thus transforming science into marketing support. Twenty-five million Americans were eventually prescribed Vioxx as an aspirin-substitute thought to produce fewer complications.
> Although the Vioxx scandal certainly did generate several days of newspaper headlines and intermittently returned to the front pages as the resulting lawsuits gradually moved through our judicial system, the coverage still seemed scanty relative to the number of estimated fatalities, which matched America’s total losses in the Vietnam War. In fact, the media coverage often seemed considerably less than that later accorded to the Chinese infant food scandal, which had caused just a handful of deaths on the other side of the world.
Killing an old person 7 years before they would otherwise die is not as bad as killing an infant 78 years before it would otherwise die. But is it really less than 0.1% as bad?
I mean, western companies promoted powdered milk to developing countries which likely has indirectly killed a lot of babies. They also promoted smoking, pollution, petroleum, prescription narcotics and a lot of other things that have killed a lot of people including babies.
And this is what the Socisl Credit System is trying to solve.
It’s also interesting how saying Chinese people are so different is widely accepted on HN. Can you imagine if the same comment was made about Jewish people?
I do hear others say the Chinese are the Jews of the East.
And “having dealt with Jewish vendors and mfgs for years that is a scary scenario. The whole culture of trust / fairness / honesty is very different from the west.”
> I do hear others say the Chinese are the Jews of the East.
Sure, if the Jews were most of the population of the US and Europe instead of being about 2%.
The Hakka are the Jews of the East. (Or, in India, the Parsis are.)
Yeah, having dealt with Chinese vendors and mfgs for years that is a scary scenario.
I've met contractors who did extensive work for businessmen in the US, who then turned around and told the contractor, "You want to be paid? Sue me!"
The whole culture of trust / fairness / honesty is very different from the west.
Is it really that different? There are some people who are good and some people who end up being opportunistic in evil ways. The more I learn about differences across cultures, the more I conclude that the differences are always ones of degree, and the differences are made more visible due to the cultural contrasts. That said, is there more rule of law and enforcement around IP issues in the west than in China? I suspect that's also true.
Dealt with our products being knocked off for years, wouldn’t want to buy cancer meds ever!
There are also people in the west who aren't above faking treatments for cancer.
Being Chinese myself, I can say the moral standard of normal Chinese are more bipolar than western world.
Some are incredibly kind and fair.
Some are incredibly immoral, who can be viewed as demon incarnations. See example like this: https://www.zhihu.com/question/53610601 (manufacture human monster slave to use as worker as fake beggar)
Some are incredibly kind and fair.
Some are incredibly immoral, who can be viewed as demon incarnations.
You can find comparable extremes in all places.
Sure, as I mention, it's more.
The example I cite here is well-knwon, and yet it exists still today.
Can you imagine western countries allow this to happen regularly?
As time goes on, people adjust to the rule of law and societal standards. What happens in the west is that the "optics" are far better. Much of the corruption remains, however. Unfortunately, I think that's baked into reality and human nature.
No objections.
Just to point out the status-quo.
people are different because of their circumstances. Not because of their skin color.
Who implied racial judgement here?
> There are also people in the west who aren't above faking treatments for cancer.
So true, here you go: https://www.dw.com/en/cancer-drug-scandal-german-pharmacist-...
The free press and independent justice system makes the difference.
The free press and independent justice system makes the difference.
Those can and do make a difference. No system is perfect, however. Chinese culture has an extensive heritage of moral philosophy. Despite that, it's still been shown that it's possible to overturn the social order there with massive consequences. The west certainly isn't above that sort of chaos. France and Germany, the largest economic powers of continental Europe, have that in their history. The US isn't entirely above this kind of chaos, either.
The press in the west also follows a propaganda model.
https://www.amazon.com/Manufacturing-Consent-Political-Econo...
Justice systems in the west have been known to cooperate with the authorities in miscarriages of justice, particularly in wartime or when subject to near-wartime hysteria.
When it comes down to it, there is always a struggle between good and evil in all times and places. The really tricky part of it is this: The worst evils disguise themselves as movements of good and justice. People and movements should be judged by their actions. Ask: Who is committing violence against whom? Who abets or tacitly accepts bad actions? Who is willing to call out their own side and their own tribe when they do wrong?
The left/right political spectrum ceases to have meaning when you look at it that way. The Authoritarian/Anti-authoritarian spectrum and the tribalist/universalist spectrums hold much more value.
Imagine if google was in the business of faking cancer treatments with Army hospitals. That would basically be Baidu and the PLA.
Google is not that corrupt yet, thank goodness. However, to respond to the idea in the other comment: That Chinese people, Chinese society, or Chinese culture is somehow the root cause, I think we should be calling out Baidu and the PLA in particular.
Oh, I totally believe those things would happen in the states if we didn’t have much better rule of law than China. It’s a corrupt government, but culture that it is the problem.
“But not culture that is the problem”
>Is it really that different? There are some people who are good and some people who end up being opportunistic in evil ways. The more I learn about differences across cultures, the more I conclude that the differences are always ones of degree, and the differences are made more visible due to the cultural contrasts.
Exactly. When you have a culture that more often accepts scams as necessary to succeed and another culture that shuns them, you will probably see disparities in the percentages of people in those cultures who are willing to scam. Ostracism is a powerful deterrent.
The trick would be to buy the cancer meds, then send them to another lab and have them determine what it is (without telling them in advance).
Extra points if you get the lab to quantify purity instead of just finding presence.
Lots of pharma APIs are manufactured in China or India.
This is exactly why the FDA can and will inspect facilities in foreign countries.
They'll inspect, but the buyer will always do their own verification.
like any drug deal, you should test the product. not exactly a cultural difference here.
this whole thing even sounds like dallas buyers club.
Does anyone know which site they are talking about in the article ('Dances with Cancer' and "I want miracles")?
They are yuaigongwu and 51qiji. They have helped numerous patients in China. To be fair, they are mostly patient forums helping each other and most of the medicine for cancer can be purchased with discount in China. They are less expensive than the US but still expensive which is why some poorer patients are seeking alternatives/self made medicine.
Thanks! Do you know who "Bean Spirit" is? I was going to guess 豆神 but not sure since spirit can be a lot of words.
憨豆精神 if you know chinese.. He was legendary and inspired many ppl including me. Sadly he passed away last year.
Thank you! Such a shame to hear. I will definitely browse the site to read about his legacy.
This will be the normal state in India too if we buckle to US lobbying and capitalist pressure. There is extraordinary and continuous (every-day) compulsion on Indian diplomats, trade officials and politicians to keep expanding the scope of the Patents Act, reduce the scope of generics, and decrease the 'innovation threshold' of what can be patented so as to allow continuous ever-greening of drugs. I am not confident that the Indian government can withstand this in the long term.
As opposed to the US,
In the US, people need not resort to smuggling. Rather, they consume drugs intended for non-human animals.
https://mashable.com/2017/08/06/fish-antibiotics-america-hea...