From the corridors of multinational headquarters in the US to the counters of Cairo chemists, Serene Assir investigates how few decision-makers in the pharmaceutical world ponder the human cost of their business The middleman Egypt's leading pharmacologist explains to Al-Ahram Weekly why WTO-linked patency agreements will have a negative effect on the country , president of the Egyptian Pharmacologists' Syndicate and head of a local pharmaceutical enterprise, the Medical Union Company, has been an outspoken critic of the Trade-Related Intellectual Property Rights (TRIPS) agreements, and the United States administration's efforts to discontinue local pharmaceutical production. Since TRIPS came fully into force on 1 January, Gad's voice has been linked in the Egyptian press with the global fight to put people before profit. Kindly comment on the TRIPS- related US pressures on Egypt. To all intents and purposes, TRIPS is a means to oppress the people of poor countries. In Egypt, it was after the start of the extendible five-year grace period given to new signatories to the WTO that the pressures from the US began to weigh heavier. Since the start of this year, when the grace period expired, there have been various moves made by large US companies concerning 500 new medicines, licensed prior to the expiry of the grace period. The PhARMA lobby -- which acts in the name of US multinationals -- began to implement a number of unethical policies in the form of direct political pressure via the US administration. If the multinationals felt they had legitimate reason to act against the Egyptian companies, they would have taken legal action, but they did not. How does Egypt benefit from the local production of generic drugs? When Egypt produces generic drugs, they are sold at cheap prices. While a model drug produced by a US firm may cost LE95, an Egyptian generic equivalent will be LE35. You need to consider that everyone here, be it a minister or a beggar, is on a limited budget, because no one here has more than one form of income. Besides, pharmaceutical production in Egypt is remarkably successful. In fact, we are on a world-class level. But if it is so advanced, then why has the Egyptian pharmaceutical sector not invested more in research and development? India and Brazil have been relatively successful in withstanding US pressure thanks precisely to such investment. But we have invested. In order for companies to reach a world-class level, there has to be research and development. You mention India and Brazil as role models, but while their level of production is very high indeed, they have not actually invented anything. Nor have most European countries, for that matter. Most drugs are invented in the US and Japan. The rest simply buy the formula. But many countries that may not afford the full-fledged development of a new drug nonetheless carry out research that the multinationals then rely on... When people talk about research and development, they very often ignore the significance of different stages of the process. In fact, it is the last stages that are the most important. As for testing, we do carry out our own tests here. The discovery itself, on the other hand -- very often it is a result of sheer coincidence. How will TRIPS-related pressures affect essential drugs in five, 10 or 50 years? In Egypt, there are approximately 7,500 drugs on the market, only 500 of which are essential. About 60-70 drugs target each serious disease. At the moment, the number of new drugs introduced into the world market does not exceed 10 per year. Not all are in demand, for they are often merely developments of older drugs that provide no new benefits -- luxury products. Also, as new drugs are released, they must be looked at with care. We must not rush to register them for they may have as yet unidentified side effects. Here in Egypt, we must not be afraid, because we already have enough useful medicines to keep us going for decades. If there are breakthroughs, such as a drug which cures cancer, then of course we would buy the licence and provide the population with it. But for now, we have seen no new drugs that would bring significant improvements to the quality of life of patients. But, extremely serious diseases notwithstanding, why are developments of older drugs seen as luxuries when they may be integral to a particular patient's survival? A patient needs to know how to take care of himself given the restrictions that his illness entails. If a diabetic wants to use fast-action insulin because he wants to be able to eat whatever he likes, then he has to deal with the consequences this will have on his financial situation. Interview by Serene Assir
