Health reality on drug patents — Philip Stevens

I am reposting this good article by a good friend, Philip. Enjoy.


MAY 3 — Debates on how to improve healthcare in developing countries often start from the same premise: patents can potentially raise drug prices, so they should be abolished for better public health.

In the early 2000s this argument drove the campaign against patents on HIV drugs in South Africa. This week it is motivating campaigners against the Regional Comprehensive Economic Partnership in Asia — a proposed Free Trade Agreement between 16 Asian countries that may impose new intellectual requirements.

NGO disquiet about drug patents has even led to the creation of a UN High Level panel on access to medicines, due to report its recommendations in New York next month.

Such concerns may in fact be overblown. This is an implication of an interesting new study by researchers at the University of Ottawa and published in April by the World Intellectual Property Organization (WIPO) in Geneva.

To better understand how patents impact access to medicines, the researchers counted how many of the World Health Organisation’s (WHO) List of Essential Medicines are subject to patent protection in developing countries. This list contains 375 or so medicines considered most important by WHO experts.

It’s a hugely influential list, and one based purely on the clinical usefulness of a medicine, not cost or patent status. Developing country governments and large international donors use it to guide which medicines they will procure.

The researchers checked national patent registries in developing countries and double-checked with manufacturers. They found that patents for 95 per cent medicines on the list had expired.

Put simply, patents are not relevant to the vast majority of drugs typically used by physicians in developing countries.

Most of the remaining 5 per cent of medicines — around 20 products — on the WHO list with patent protection are for HIV/AIDS. But patent owners either don’t register or enforce their patents in the poorest countries. For middle-income countries, manufacturers often enter into voluntary licensing deals with generic manufacturers to broaden access, meaning there are cheap generic copies on the international market.

The one medicine with no generic equivalent is the cancer drug, bevacizumab (marketed as Avastin by Swiss patent-owner Roche). This modern so-called ‘biologic’ drug is used against many cancers, and works by starving tumours of their blood supply through blocking a key protein.

Patented or not, these biologic drugs are difficult for generic competitors to copy cheaply.

Unlike most drugs, which are chemically synthesised and made from just a few  molecules, biologic drugs are manufactured in living systems such as plant or animal cells, and have complex molecular structures. Their manufacture demands significant investment and technical know-how, meaning such drugs will never be as cheap as, say, generic aspirin.

One implication of the study is that if patents were abolished tomorrow it would make little difference to the cost or availability of most medicines used in developing countries.

Even so, these medicines are frequently unavailable in public health systems.

In 2014, researchers at the University of Utrecht in the Netherlands found that, on average, essential medicines are available in public sector facilities in developing countries only 40% of the time.

While generic medicines are cheap to make with no royalties to pay, they are still too costly for most people in developing countries.

One example from the WHO list is budesonide, commonly used by asthma sufferers. A single inhaler costs a staggering 50 days wages in Mozambique. In the US, one inhaler costs only US$5 to US$7 (RM20 to RM27) — around 30 minutes work on the median hourly wage.

The reasons behind the expense and scarcity of essential medicines in developing countries are complex, but failures of governance loom large.

Mark-ups along the distribution chain inflate the final price of medicines and include import tariffs, sales taxes, value-added taxes and retailers’ and wholesalers’ margins. In Kenya, mark-ups add 300 per cent to the manufacturer’s price; in Brazil it’s 200 per cent, says IMS, the global healthcare data provider.

Dysfunctional medicine supply chain management is another culprit. A 2015 survey by humanitarian NGO Medecins Sans Frontières reported one in three health facilities in South Africa have shortages of key HIV and tuberculosis drugs. The drugs are imported in sufficient quantities but fail to reach patients due to “local logistical and management problems, ranging from inaccurate forecasting to storage or transport issues”, said MSF.

Governments under-invest in health too. While most European Union countries commit 8 per cent to 11 per cent of GDP to health, few Asian and African countries spend more than 5 per cent: not nearly enough given their enormous health challenges.

These are the major influences on access to medicines. Public health would be best served if the political focus were on these issues, rather than patents.

* Philip Stevens is senior fellow at the Southeast Asia Network for Development (SEANET) and director of Geneva Network, a research organisation focusing on health, intellectual property and trade.


On tobacco plain packaging proposal in Singapore

This is my letter to the HPB yesterday. The auto reply said they have received it and will look into it.

Subject: Singapore’s plan on “Standardized packaging” of tobacco products

Health Promotion Board
3 Second Hospital Avenue,
Singapore 168937

Dear Sir/Madam,

I have read your campaign to control tobacco use and promote good health among Singapore citizens, it is a good objective. But I notice that you also plan to introduce or legislate “standardized packaging” or “plain packaging” in tobacco products, and I think it can adversely affect Singapore’s good image on protecting intellectual property rights (IPR).

It is true that smoking is dangerous to one’s health. I myself am not a smoker, never smoked a single stick in my whole life, never worked for the tobacco industry or its allied industries. But I think people have a choice for their body. They recognize the danger of smoking — and drinking, drugs, over-eating, sedentary lifestyle, etc. — and still they do it. They compare the health risks with the pleasure of those actions then they decide whether to continue doing it or not; if they continue, whether to smoke 1 or 20 sticks a day, drink 1 or 10 bottles of beer a day, etc.

Plain packaging (PP) is wrong for the following reasons.

  1. Singapore is known for its clear and strong property rights protection, both physical and intellectual property. Abolition or significant reduction of the trademarks and corporate logo of tobacco companies via PP will dent this image and put Singapore’s adherence to IPR protection in a question mark.
  1. If Singapore is to be consistent in its policy, then it will be pressured in the near future to also introduce PP for alcohol products like beer and whiskey, soda, chocolate bars, other high sugar, high fat content meals and snacks.
  1. People who derive pleasure in smoking will continue to smoke despite PP and they will likely shift to cheaper and illicit products. Overall smoking incidence can either flatline or even increase because tobacco companies will produce cheaper but cool-tasting products, which will attract new  smokers or entice the few-sticks-a-day smokers to become one pack a day smokers. PP will only adversely affect the sale of known and premium products of the big multinational tobacco  companies but not the cheap products of lesser known companies.
  1. If drawn in a graph, the supply curve of cheap cigarettes will move to the right as manufacturers of premium brands will soon produce lots of plain pack but cheap cigarettes. Equilibrium price goes down while equilibrium quantity goes up, even if the demand curve does not move.

Discouraging the people from smoking can be done via more public education. The graphic health warnings, campaigns by the  Ministry of Health and health NGOs or groups are part of such public education.

But some people will continue to  smoke – and over-drink, over-eat, over-sit in  sedentary lifestyle – despite learning more and new things  about the dangers of smoking, over-drinking, and so on. Government cannot micro-manage the lives of people all the  time. What Singapore should continue protecting is its image  as the bastion of IPR  protection, whether companies are in  IT, pharma, healthcare, hotels, food,  alcohol or tobacco.

Thank you very much.


Bienvenido Oplas, Jr.
President, Minimal Government Thinkers
Manila, Philippines

More on the panel on property rights, ALF 2016

Reposting this report by Yogi Nair, a summary of the panel discussion on property rights.

Event report –Protecting Yourself Against Daylight Robbery – Current Challenges to PropertyRights
(Session sponsored by the Property Rights Alliance)
Saturday, 20 February 2016, Asia Liberty Forum 2016

Chair: Wan Saiful Wan Jan, Institute for Democracy and Economic Affairs (IDEAS), Malaysia (holding the microphone in this photo)

Speakers (left to right, photo)
– Lorenzo Montanari, Property Rights Alliance, USA
– Barun Mitra, Liberty Institute, India
– Kriengsak Chareonwongsak, Institute of Future Studies for Development, Thailand
– Julian Morris, Reason Foundation, USA


Mr Lorenzo Montanari from Property Rights Alliance (PRA) began the session by proclaiming that “property rights are human rights.” PRA helps develop the International Property Rights Index (IPRI), which ranks countries according to the level of protection which is afforded to physical and intellectual property. Based on the IPRI, Mr Montanari demonstrated the significant correlation between stronger property rights protection with greater economic growth rates and average income levels.

Barun Mitra of Liberty Institute, spoke about the connection between the lack of property rights protection with the prevalence of poverty. Mr Barun said that poverty in India is so widespread, because there are insufficient laws to protect the rights of the poor. As a result, the poor are often unable to capitalise on their assets. India’s original constitution recognised property as a fundamental constitutional right. Unfortunately, in 1978, this provision was removed.


In advocating for stronger property rights, Mr Barun encourages local communities to develop a spirit of entrepreneurship on their own. These include the cultivation of their own land and construction of new community buildings. Such initiatives do much to ameliorate the ill effects of weak property rights for the poor in India. “Let’s make intellectual property rights the issue of the century.”

With a particular focus on intellectual property, Dr Kriengsak Chareonwongsak spoke next about the reasons why developing countries often lag behind developed ones. These include high levels of corruption, poor enforcement of laws, and incompetence of public servants in government institutions when dealing with intellectual property rights issues. As a result of such deficiencies, vibrant innovation is often missing from developing nations, as many would-be innovators see no prospect of maintaining ownership over their work.

One solution that Dr Kriengsak proposes is that governments include private research as public goods. He opines that this will persuade governments to appreciate innovation, because they are paying for it. This would also prevent ‘stealing’ from other countries and competitors through legal processes. More importantly, such a strategy will also give the poor equal access to those intellectual resources.

In the final segment of this panel discussion, Julian Morris of Reason Foundation examined the importance of trademarks. He said that trademarks matter, as it facilitates identification and helps protect consumers against fraud. Furthermore, trademarks enable more effective product differentiation, thus helping producers build stronger reputations – which in turn drives innovation that improves quality and efficiency.

Mr Morris also pointed out that trademarks are immensely valuable; the top ten trademarks in the world alone are worth over half a trillion dollars. In recent times however, trademarks have come under threat. Inappropriate classifications may result in the registration of identical trademarks by different producers for identical goods. Weak enforcement has also lead to mass theft of trademarks by local producers in developing countries, such as in the case of Lacoste’s famous crocodile. Results from poor enforcement can sometimes be deadly, particularly in the case of counterfeit medicines.


Mr Morris said that such threats can be resolved through a more refined classification system worldwide, the legislation of harsher punishments for violations of trademarks, and the removal of regulations that undermine trademarks, such as plain packaging.

(Prepared by Yohannan “Yogi” Nair)

TPP, medicines patent and tobacco trademark

After the 4th Asia Liberty Forum (ALF) ended in Kuala Lumpur on February 20, SEANET organized a small group discussion on “business friendly regulations”, same hotel venue. I was one of those invited. Below, Wan Saiful Wan Jan, CEO of IDEAS and Director of SEANET, spoke to explain once again what the meeting-seminar was all about.


Aside from independent think tank leaders from some ASEAN countries, some friends outside the region were also there, like Barun Mitra, Cris Lingle, Julian Morris, Lorenzo Montanari.

I gave a brief presentation. Brief as in 8 minutes or less.


TPP’s liberalization agenda will:

  1. Force open members’ economic sectors such as agriculture, affect poor peasants, women
  1. Further push them into poverty, compete with giant agricultural corporations from more developed countries
  1. Increase corporations’ access to indigenous people’s lands and territories for resource extraction without their free prior informed consent (FPIC)
  1. Undermine country’s right to reject genetically modified

organisms (GMOs), subject those GMOs to prior risk assessment; ensure uninterrupted trade for GMOs to the benefit of major GMO producers and exporters like the US and Canada

  1. Permit corporations to violate labor rights by making it easier to offshore jobs to countries with lower labor standards
  1. Encourage more inflows of migrants who later forced to become undocumented migrants  to add more cheaper and docile labor


  1. Endanger people’s right to quality and affordable healthcare due to strict intellectual property rights (IPR) on patents, data monopolies to medicines
  1. Make educational materials become expensive with strict IPR
  1. Violate internet users’ privacy rights and will stifle creativity and freedom of expression through severe copyright rules
  1. Mean death to democracy, allow corporations to use investor-state dispute settlement (ISDS) to attack public interest laws to increase their profits; corporations suing governments over living wages, environmental protection , people’s access to public utilities
  1. Have knock-on effects on the whole region, have potential to be the standard that all future trade deals will follow
  1. Promote the hegemony of corporations, neoliberal regimes and political and economic dominance of the US and other powerful States over the developing and underdeveloped economies of the world.

Among the prominent arguments why people hate the TPP and other FTAs with the US and EU is that stronger IPR protection would mean more expensive medicines, affecting even off-patent, generic drugs. Is this true?


No. Perhaps all TRIPS flexibilities with regards to newly-invented medicines were respected by the TPPA. Like these texts, the red comments on the right are mine.

Then I added another aspect of IPR infringement, the abolition of trademarks and brand logo for cigarettes.

Concluding Notes:

  1. Joining the TPP has more gains than pains for member-countries, especially in exports and overall GDP expansion.
  1. IPR health provisions in TPP not scary, apply only to newly-invented medicines and not to cheaper generic drugs. Existing TRIPS flexibilities for new meds are maintained.
  1. Possible that generic pharma lobby + anti-capitalism, anti-globalization NGOs created more fear than what the TPPA actually provides.
  1. More to fear in government taxation of medicines, mandatory drug price discounts and price controls, than IPR protection.Brief presentation, I think I spoke for only 7-8 minutes, then the others gave their own inputs and insights on other topics. The full 14-slides presentation is available in slideshare.


Meanwhile, the debate seems raging in Malaysia now regarding their government’s plan to introduce plain packaging in tobacco products too. All these news reported since last week.

plain pack

It’s now a Singapore-Indonesia-Malaysia triumvirate of tobacco plain packaging legislation. Soon it will infect the governments and stakeholders in the Philippines, Thailand, Vietnam, etc. And if they succeed, next would be beer, whiskey, other alcohol products? Then chocolate bars, soda and cola. The WHO should be involved in this new government initiatives. I will follow this development.

ALF 2016, Panel on property rights

The 4th Asia Liberty Forum 2016, #AsiaLF16, has successfully ended in Kuala Lumpur last Saturday night. Among the important panel discussions was the one on “Protecting Yourself Against Daylight Robbery — Current Challenges to Property Rights”.

Photo below, holding the microphone is Wan Saiful Wan Jan, CEO of IDEAS Malaysia, who chaired the discussion. The speakers from left:  (1) Lorenzo Montanari of Property Rights Alliance (PRA), Washington DC, USA; (2) Barun Mitra of Liberty Institute, India; (3) Kriengsak Chareonwongsak of the Institute of Future Studies for Development, Thailand; and (4) Julian Morris of Reason Foundation, USA.

Lorenzo spoke about the International Property Rights Index (IPRI) annual reports, especially the latest, 2015 Report.

Barun talked about fighting for property rights of poor rural workers and households in their tilled land in India.

Julian talked about IPR, especially of trademarks and company branding. His paper title was witty, “Marks vs. Marx”, the former refer to trademarks, the latter refer to IPR confiscation and stealing/socialization.

Among the slides shown by Julian. An example of a medicine whose products and corporate brand/logo was copied and stolen to sell substandard or fake medicines, which can have serious or even fatal consequences to patients.

Plain packaging.png
Plain packaging of cigarettes, the logo and brands of Winfield and Marlboro were removed, only their product name is displayed. Further below, when plain packaging is applied on softdrinks/soda and beer.

I don’t smoke, never smoked my entire life, I derive zero pleasure in smoking, but I respect other people’s decision to smoke. It’s their life, their body, they can do whatever they want with their life so long as they do not harm other people, like puffing heavy smoke in an enclosed room with many non-smokers inside.

I think people should not smoke, but if they decide to smoke because they derive some pleasure in smoking — the same way that I derive pleasure in drinking with friends, frequently when I was still a bachelor, and seldom now with a family and 2 young girls — then their freedom to choose which cigarette products or brands to take should not be curtailed by the government.

After all, the government is a huge hypocrite institution that says “promote public health, discourage smoking and drinking” on the left hand, then happily and gleefully collects billions of pesos or dollars of “sin tax” revenues every year from more smokers on the right hand.

Meanwhile, I am thankful again to EFN Asia and FNF regional office for giving me a travel grant to attend the 4th ALF. Thanks Siggi, Pett, Jules.

Asia Liberty Forum and property rights

* This is my article in BusinessWorld yesterday. #AsiaLF16

The classical liberal philosophy of more individual freedom and more personal/parental responsibility, free market and less government intervention and taxation is not a popular personal and political philosophy in Asia yet, at least compared to similar movements in the US and Europe.

So annual events like the Economic Freedom Network (EFN) Asia conference, and now the Asia Liberty Forum (ALF), are very helpful in asserting the virtues of classical liberal, aka “libertarian” or “free market” philosophy. This concept is vastly different from other labels like “neo-liberal” and “US conservatism”.

The three-day 4th ALF event is held here in Renaissance Hotel Kuala Lumpur, Malaysia. This is a huge international event from Feb. 18-20 with many participants from Asia, US, and Europe. The main sponsors of this year’s conference are the Atlas Economic Research Foundation in Washington DC, the Center for Civil Society (CCS) in Delhi, India, and the Institute for Democracy and Economic Affairs (IDEAS) in Malaysia.

Among the important panel discussions in the conference will be on “Protecting Yourself Against Daylight Robbery — Current Challenges to Property Rights” on Day 3. The session will be chaired by Wan Saiful Wan Jan, CEO of IDEAS Malaysia. The speakers will be (1) Barun Mitra of Liberty Institute, India; (2) Kriengsak Chareonwongsak of the Institute of Future Studies for Development, Thailand; (3) Julian Morris of Reason Foundation, USA; and (4) Lorenzo Montanari of Property Rights Alliance (PRA), Washington DC, USA.

The protection of private property rights is among the hallmarks of a free and dynamic society. If other people can say that “Your car is also mine; your house is also mine; your farm is also mine. I can enter and use them anytime I want,” then society can easily degenerate into chaos and disorder. No meaningful economic growth and social development can happen in this type of environment.

The PRA has developed the annual International Property Rights Index (IPRI). The index is composite for a country’s performance in three areas: (a) legal and political environment, (b) physical property rights protection, and (c) intellectual property rights (IPR) protection. The scores range from 1 (poorest) to 10 (best).

I made a short study about the performance of some ASEAN countries in terms of property rights protection covering eight years from 2008 to 2015. Singapore and Malaysia continue to have high scores overall in property rights protection. The Philippines made a modest improvement in its global ranking, from 87th in 2011 and 2012 (out of 130 countries), it jumped to 77th in 2013 and 65th out of 129 countries in 2015.

If we observe the Philippines, the bulk of property rights protection — in malls and shops, hotels and restaurants, banks and condos, schools and universities, airports and seaports, etc. — is heavily privatized through the tens of thousands of private security agencies. It is not the police or army or barangay security personnel who guard and protect these businesses and residential, commercial areas, despite the huge and multiple taxes and fees that people pay to the government annually.

And this is an indicator that governments often forget their main purpose, their raison d’etre, which is the protection of the people’s right to life (against bullies and murderers), right to private property (against thieves, vandals and destroyers of property) and right to self-expression (against dictators). To have a rule of law.

When governments are busy giving away endless welfarism and subsidies, collecting endless taxes and fees, imposing endless regulations and restrictions, running banks, casinos, TV stations, and other businesses, there is a tendency to set aside its rule of law function and it is unfortunate.

Government should be big enough in enforcing laws on private property and citizens protection, and it should be small enough in intervening too much in the people’s daily lives, hence requiring small and few taxes to sustain itself.

Bienvenido S. Oplas, Jr. heads the Minimal Government Thinkers, a member of Economic Freedom Network (EFN) Asia, and a Fellow of the South East Asia Network for Development (SEANET)

Plain packaging and trademark busting

Trademarks and brand logo are important to distinguish companies and producers from each other. A customer can say, “I don’t want to ride airline X because they are frequently late/delayed, nor airline Y too because they are expensive, I prefer airline Z because their fares are cheap they mostly fly on time.” That is branding from the perspective of customers.

When government or many groups dislike or hate something, this is how regulations and later prohibitions look like:

  1. Raise the tax, make it more expensive.
  2. Restrict or prohibit advertising to certain events.
  3. Mandate graphic warnings, like “Smoking kills” and show ugly pictures of dilapited lungs and mouth.
  4. Actual product restrictions to certain consumers, like “for people above 21 years old” and so on.
  5. Ultimately, plain packaging. Like all tobacco products, all beer and wine products, all  chocolate bars, etc. to be labelled as plain “cigarettes” or “beer” or “red wine” or “chocolate”.

Boring and lousy, right?

Of course smoking — and drinking lots of alcohol, and taking lots of soda, ice cream, eating lots of fatty, salty, preserved food, sedentary lifestyle, etc. etc — is bad for people’s health.

But people — not the state or media or the health NGOs, etc. — own their body. People recognize the risks of smoking, drinking, drugs, etc. and they compare such health risks with the pleasure of smoking and drinking. Then they decide whether to continue doing it or stop; if they continue, whether to smoke 1 or 20 sticks a day, drink 1 or 6 bottles of beer a day, etc.

Too much nannyism by the state purportedly to “protect public health” is wrong, and is a clear smoke screen and excuse for more taxation, more regulations, prohibitions, more government.

Plain packaging of tobacco, beer, whiskey, chocolates, etc. in the Philippines, I do not think this kind of legislation will prosper here. Mainly because legislators themselves are among the big fans of branded tobacco, beer, wine, etc. But it is an opportunity for big time extortion by health regulators and/or legislators.

Meanwhile, the graphic photos law against tobacco consumption, the implementing rules and regulations (IRR) to be signed soon,