Pharmaceutical News

How pharmaceutical giants kill the poor

International intellectual property rights are increasingly serving the needs of the global pharmaceutical industry, writes John Christensen and Khadija Sharife.

IF China is the factory of the world, then India is the pharmacy of the world, exporting over 60 percent of production to the developing world, most noted for supplying generic ARV medicines.
Courtesy of India’s generic drugs, such as CIPLA’s (2001) triple fixed dose combination tablet (FDC)-approved by the WHO, prohibitive costs of US$10 000-US$15 000 per person each year were reduced to US$350, further decreasing to US$140 annually.
Then came 2005, signifying the deadline of the transition period for compliance by low- and middle-income countries (LMICs) to the Trade-Related Aspects of Intellectual Property Rights Agreement (TRIPS), designed to protect the “intellectual property” rights (IP) of Big Pharma.
Prior to TRIPS, drugs were considered “basic needs”; countries were better able to formulate systems structured to serve socio-economic needs. Unlike many developing countries in the position to develop local industries, India did not buckle to the pressure exerted by systemically powerful nations eager to penetrate “public health” markets.
Post-2005, India continued its attempt to manoeuvre, as smoothly as possible, the jagged edges of TRIPS’s draconian IP rule-of-law: In 2007, India’s High Court ruled against the Swiss pharma giant Novartis, refusing the company right of patent for a modified version of an existing drug — an old IP move feigning “innovation”, designed to prolong patent life.
By 2008, 96 of 100 countries purchased generic ARVs from India, with Indian products comprising 80 percent of donor-funded developing country markets, and 87 percent of total purchase volumes.
In Africa, just 7 percent of ARVs are Western patented medicines, while more than 90 percent are generic drugs, chiefly produced by Indian corporations.
The drastic cost difference between the two has often been packaged as one formulated to recoup costs of research. Big Pharma claims that generic companies — manufacturing existing medicines, are able to bypass these costs. Yet, as has been frequently noted, such claims cannot withstand scrutiny.
As MIT Professor Rebecca Henderson noted in a Pfizer newsletter over a decade ago: “Research has been, in general, largely funded by the American taxpayer, and in the past has resulted in products that have revolutionised medicine.”
In 2003, Médecins Sans Frontierès documented in a letter to Robert Zoellick, US Trade Representative, ahead of CAFTA negotiations: “MSF was able to pay between 75 percent and 99 percent less for generics than the government of Guatemala paid for originator drugs. For example, the price of the ARV d4T (40mg) from Bristol-Myers Squibb was US$5 271 per person per year compared with just US$53 per person per year from a generic manufacturer.”
Ironically, some 80 percent of Western ARVs are purchased in developed countries, rendering developing markets in continents like Africa, almost irrelevant.
South Africa, of course, was in the eye of the storm when 39 drug companies brought suit against the government for including generic medicines in the legal framework of the Medicines Act.
In April 2001, the companies withdrew their suit following intense engagements on the part of the government, and especially, national and international civil society resistance, notably the Treatment Action Campaign (TAC).

But the rumble began long before that, evidenced in the “Battle of Seattle” (1999) when as many as 100 000 protestors took to the streets, challenging the structural injustice of globalisation.
India’s own shining progeny Fareed Zakaria, would describe the protests that helped give birth to global change as, “anti-democratic”.
According to Zakaria, those who protested were “rich and privileged”. (The rest, we beg to differ, could not afford the plane tickets.)
Yet beyond the obvious public health genocide caused by the greed of pharmaceutical corporations, intentionally holding developing governments hostage (according to the Doha Declaration: “The TRIPS agreement does not and should not prevent members of the WTO from taking measures to protect public health”), there exists another more subtle form of exploitation: IP constitutes the most substantial class of intangible assets — geographically mobile sources of vast corporate income that remain difficult to financial evaluate via arms length transfer pricing.
This is especially true concerning transactions between subsidiaries of the same corporation. More often than not, intangible assets are shifted to secrecy jurisdictions such as Delaware, specialising in IP holding companies that provide 100 percent tax exemption on royalty income — one of several tax holidays.
Big Pharma corporations like Pfizer, Novartis, Glaxosmithkline — as well as over 60 percent of Fortune 500 multinationals, all maintain entities in Delaware, taking full advantage of ring-fenced legal and financial opacity tools.
In addition to banking secrecy and zero disclosure of beneficial owners, Delaware allows for parent companies to establish holding companies within two days, producing nothing, conducting no economic activity in the state, and generally hosting just one shareholder (the parent company).
Such entities, allowing the parent company to pay the newly created entity a “fee” for use of IP, serves as a passive conduit converting taxable income to passive non-taxable profit. The entity’s sole purpose is to own and “manage” laundered income generated from IP.
Intentionally weak and easily circumvented global rules regulating trade facilitates considerable leeway to exploit — and misprice, the value of intangible assets. A Pfizer patent, for instance, may be worth US$100 million or a US$10: by and large, the company internally determines the value of IP, imputing a “market price”.
Intra-company trading, accounting for 60 percent of global trade, is “governed” by arms length transfer principles, a system endorsed by the OECD, itself comprised of the world’s systemically powerful “developed” countries.
The OECD acknowledges too that intangible assets are “one of the most important commercial developments in recent decades”. Intra-company mispricing not only distorts and manipulates the proposed neoliberal concept of the market (as most efficient allocator of price and resources), but simultaneously drains developing countries of sustainable tax revenues.
More recently, the Anti-Counterfeiting Trade Agreement (ACTA), secretly drawn up by an ad-hoc group of rich countries beginning in 2008, and endorsed by US President Barack Obama in March 2010, seeks to further lock down any loopholes diminishing the all-encompassing power of the IP kings.
This includes vehicles such as “borders measures” concerning any TRIPS-related goods imported, exported or “in-transit”. Vessels passing through rich countries carrying generic goods for poor countries — irrespective of whether such goods are legal at source and destination jurisdictions, may be held up for seemingly as long as the intermediary nation deems fit.
Such systems certainly promote a kind of socialism — but only for the uber-wealthy.
Meanwhile, the poor are forced to pay with their wallets — and their lives. Thanks to the system underpinning TRIPS, arms length transfer pricing, and the like, IP kings not only make a killing from patents but from secrecy jurisdictions too.

Drug Topics’ 2011 business outlook survey: Steady sailing for now

While the economy in many industries has yet to rebound, the pharmacy industry has remained strong and most pharmacists are hopeful about 2011. However, optimism isn’t running as high as it was last year, and the pharmacy community is concerned about how competition, reimbursement, and healthcare reform will affect the industry.

These are just a few of the conclusions drawn from Drug Topics’ annual business outlook survey, an online survey conducted in October that received more than 400 responses from community, hospital, and long-term-care (LTC) pharmacists.

Overall, respondents believe that the business climate looks positive for 2011. Of the 305 community pharmacists who responded to the survey, 77% believe that 2010 will be an excellent, very good, or good business year, and 68% predict that the trend will continue in 2011.

In addition, of the 96 hospital and LTC pharmacists who responded, 84% anticipate that 2010 will be an excellent, very good, or good business year, and 73% believe that will also be the case in 2011.

“I think there are a lot of very positive things going on in pharmacy, and so I think [pharmacists’] optimism is warranted, but it isn’t going to get any easier,” said Thomas Menighan, executive vice president and chief executive officer of the American Pharmacists Association (APhA). “Margins are not going to get larger. People are going to have to be more efficient. They are going to have to find ways to make the services that pharmacists can provide pay off rather than relying on buy low, sell high.”

Community pharmacists’ financial outlook

Pharmacists’ financial expectations for 2011 are generally positive, but they aren’t without their concerns.

Nearly half (45%) of community pharmacists surveyed believe that sales will increase in 2011. For those who anticipate rising sales figures, the average increase expected is 4.5%.

However, not everyone sees predicted sales in such a positive light. Survey findings indicate that 11% believe sales will decrease, and they predict an average decrease in 2011 of 2.3%.

In addition, 56% anticipate an increase to operating expenses, while 6% expect a decrease. For those who believe there will be an increase, the average expected increase is 4.1%. For those who anticipate a decrease, the average expected decrease is 1.2%.

About a third, or 35%, expect net profits to increase in 2011 by an average of 2.6%.

Half of community pharmacists believe that in their pharmacies, pharmacist salaries will increase in 2011, while 40% do not expect an increase. For the 50% who expect an increase, the average expected increase is 3.6%.

Hospital pharmacists’ financial outlook

Hospital and LTC pharmacists are less optimistic about sales expectations than are their counterparts in community pharmacy. According to the results, just 30% of hospital pharmacists expect an increase in sales in the coming year; the average increase they anticipate is 3.9%. However, only 6% predict a decrease in sales. For those who expected a decrease, the average expected decrease was 2.1%.

Most hospital pharmacists surveyed (51%) expect operating expenses to increase in the new year; they predict an average increase of 5.4%. On the other side of the spectrum, 6% of those surveyed believe operating expenses will decrease and expect an average decrease in 2011 of 0.6%.

Nearly a quarter, or 23%, of hospital pharmacists expect net profits to increase in 2011 by an average increase of 2.5%.

A significant percentage of hospital pharmacists do not believe a raise is in their future in 2011. According to the survey results, 47% do not expect a salary increase. However, 42% do believe that their pharmacies will be giving pharmacists a raise in 2011. The average increase anticipated is 3%.

Anna Garrett, PharmD, BCPS, manager of outpatient clinical pharmacy services for Mission Hospital in Asheville, N.C., believes that if pharmacists are expecting salary increases now, those increases will be more in line with cost-of-living adjustments, rather than being significant jumps in pay.

“It looks like the days when everybody is getting the huge raises are over,” said Garrett, who is joining Drug Topics’ editorial advisory board next month.

Challenges and opportunities

In any given year, the pharmacy industry will face challenges and opportunities, and 2011 is no exception. In one section of the survey, pharmacists identified the top 3 positive and top 3 negative factors that they believe will influence the industry in the coming year.

The most frequently cited positive factors expected to affect business are major brand-name drugs going off patent (cited by 62% of respondents), an increase of e-prescriptions (cited by 37% of respondents), and immunization certification (cited by 36% of respondents).

The most frequently mentioned negative factors affecting business for 2011 are expected to be the recession (cited by 77% of respondents), low reimbursement from third parties (cited by 66% of respondents), and mail-order programs (cited by 63% of respondents).

Charlie Mollien, PharmD, a staff pharmacist with Meijer Pharmacy, Jenison, Mich., and a Drug Topics Frontline editorial advisory board member, said that he is optimistic about the future of pharmacy, although he does see some hurdles. While he believes that pharmacy utilization will continue to increase, he added that low reimbursement could translate into pharmacists filling more prescriptions for less profit.

To combat the problem, and to make up profits, Mollien said, pharmacists may need to look into other areas, such as adopting education programs for smoking cessation or chronic disease management. For the programs to be successful, however, pharmacists would need to be given the time, staff, and leadership support to run them.

The biggest challenges pharmacists will face in 2011 are said to be competition from chains offering generics at low or no cost (cited by 51% of respondents), competition from mail-order pharmacies (cited by 59%), and state Medicaid rates and Maximum Allowable Cost (MAC) and Federal Upper Limit (FUL) programs (cited by 53% of respondents).

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Pharmaceutical News: December, 11

Nixon accepts pharmaceutical industry’s offer to track pseudoephedrine sales

Gov. Jay Nixon announced today that a new computerized system will help combat methamphetamine labs by blocking illegal sales of a decongestant at the pharmacy counter.

Legislators passed a law in 2008 requiring pharmacies to report sales of pseudoephedrine products electronically, but the mandate was never funded. Pseudoephedrine is meth’s main ingredient.

The Consumer Healthcare Products Association, a trade association representing pharmaceutical companies that make the over-the-counter product, volunteered to pay for the system.

Nixon accepted the industry’s offer, saying it will allow pharmacists and law enforcement to determine at the point of sale whether a buyer has bought large amounts of pseudoephedrine at various stores to skirt the legal limits.

Nixon said the system would allow people who legitimately need the cold medicine to purchase it, but will block sales to people trying to build an inventory to make methamphetamine.

Jim Acquisto, Product Manager at Appriss Inc., the company building the database, said the system likely will be up and running in about 90 days, and will connect Missouri’s database to those in Kentucky, Illinois and Louisiana.

Kansas and Iowa likely will be the next states to link to Appriss’ system, called Nplex.

Pharmacists will enter the buyer’s name into the database and get an immediate record of how much pseudoephedrine the person has bought along with a record of where and when the purchases were made. If the new purchase would put the buyer above daily or monthly limits, the purchase will be denied.

A buyer who is denied would receive a receipt with Appriss’ phone number asking the person to call Appriss for an explanation of the denial. The system is also able to spot fake identification cards, flag multiple purchasers living at the same address and track other suspicious patterns.

Appriss also will provide free training to pharmacy staff on how to use the system as well as law enforcement personnel on how to track suspicious purchases.

Local police agencies in Missouri are skeptical the new system will have an impact. They point to Kentucky, which had an increase in meth labs during the database’s first year of operation. They say Kentucky’s experience shows that the electronic system doesn’t stop meth labs.

Instead, police in Missouri have lobbied for prescription laws, saying electronically tracking sales won’t stop meth addicts from paying others to buy boxes of pseudoephedrine for them or shopping in groups.

So far, eight local governments have passed prescription laws, including Washington, Union, Poplar Bluff, Gerald, Kennett, Eureka, Potosi, Jefferson County and Farmington.

Mixed reaction to Pharmacy Voice

Newly formed pharmacy organisation Pharmacy Voice, which is the result of the NPA, CCA and Association of Independent Multiple Pharmacies (AIMp) joining forces to represent their members, has had a mixed reaction from the community pharmacy sector.

While many industry leaders and pharmacy minister Earl Howe welcomed the move, others cautioned that the group might not help to bring the sector together.

Pharmacy Voice will represent members from January with a stronger, unified voice, the associations say.

Ian Facer, NPA and Pharmacy Voice chair, told C+D when it came to representation, “the whole landscape has been fragmented and pharmacy has not been punching anywhere near its weight, it’s about galvanising that and shaking things up”.

Pharmacy minister Earl Howe welcomed the launched of Pharmacy Voice, saying a more coherent message from the sector would be “extremely helpful” for government.

And Jeremy Main, managing director at Alliance Healthcare, said he looked forward to seeing how the organisation would work.

“I really do hope that Pharmacy Voice will put pharmacy at the forefront of the healthcare agenda and really make things happen,” he said.

However, one reader posting on C+D’s website, said: “This feels like a further fragmentation of the representative power of the profession rather than a consolidation.”

And Pharmacy Voice would “be out to protect the interests of its members, the owners of pharmacies, many of whom may not be pharmacists”, the PDA Union warned.

“Their statements indicate that they have done this for the benefit of pharmacy. However, inevitably there will be a concern amongst pharmacists that they are merely protecting their own commercial interests, which may not necessarily always satisfy the broader aspirations of the profession,” PDA Union general secretary John Murphy warned.

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Pharmaceutical News: December, 10

NCPA announces Kathleen Jaeger as CEO

Kathleen Jaeger, whose appointment as executive vice president and CEO of the National Community Pharmacists Association (NCPA) was announced October 25 at NCPA’s annual Convention and Trade Expo in Philadelphia, immediately outlined several goals for advancing community pharmacy.

“Our first and foremost objective must be to ensure our patients have access to excellent quality care and pharmacy services in their community,” Jaeger said. “Second, we must continue to demonstrate the tremendous value independent pharmacists deliver to patients and the overall healthcare system.”

NCPA must also strengthen the financial stability of independent community pharmacies and drive their economic growth, she said. It is also vital that they be viewed as part of the healthcare reform solution. “My main focus is to put pharmacists back central to patient care. We would like to see them expand the services that they provide to patients and their communities.”

At the same time, Jaeger realizes that her job — and the goals of NCPA leadership — will be challenging. “The nation’s economic crisis is driving serious debates over healthcare costs and the federal deficit. As reform is implemented, the country will become even more polarized. And with each passing day the healthcare sector grows more competitive,” Jaeger said.

Jaeger is well equipped to deal with the challenges facing pharmacists and to advocate for and advance the pharmacy profession. She is the daughter of an independent community pharmacist and is a pharmacist herself. She earned a BS degree in pharmacy from the University of Rhode Island and a Juris Doctor degree from Catholic University. Jaeger then chaired the food-and-drug practices of two law firms, first for McKenna and Cuneo and later for Kirkpatrick and Lockhart. From 2002 through 2010, she served as president and CEO of the Generic Pharmaceutical Association.

“Kathleen brings to NCPA a demonstrated track record of successful advocacy, along with a first-hand pharmacy background,” said NCPA president Joseph H. Harmison, PD.

Court: FDA can regulate e-cigs as tobacco products

RICHMOND, Va. A federal appeals court says electronic cigarettes should be regulated as tobacco products by the Food and Drug Administration rather than as drug-delivery devices, which have more stringent requirements.

The ruling means their makers won’t have to conduct expensive clinical trials to prove to the FDA that the products are safe and effective as a stop-smoking aid.

The decision is a setback to the FDA and other public health organizations, which had argued e-cigarettes should be regulated like nicotine replacement gum or patches. They also have warned that e-cigarettes contain dangerous chemicals and are being marketed to children.

A three-judge panel of the U.S. Court of Appeals in Washington backed a lower court ruling that the devices should be considered under the agency’s authority over tobacco, which means they would follow the same restrictions as traditional cigarettes and tobacco products.

Some sellers of e-cigarettes sued the FDA last year after the agency told customs officials to refuse entry of shipments into the U.S. A federal judge ruled in January that the FDA can’t stop those shipments, saying the agency had overstepped its authority.

E-cigarettes are plastic and metal devices that heat a liquid nicotine solution in a disposable cartridge, creating vapor that the “smoker” inhales. A tiny light on the tip even glows like a real cigarette.

Nearly 46 million Americans smoke traditional cigarettes. About 40 percent try to quit cold turkey or with other nicotine replacements each year, according to the Centers for Disease Control and Prevention. But unlike patches or gums, e-smokes have operated in a legal gray area.

Users and distributors say e-cigarettes address both the nicotine addiction and the behavioral aspects of smoking – the holding of the cigarette, the puffing, seeing the smoke come out and the hand motion – without the more than 4,000 chemicals found in a traditional cigarette.

First marketed worldwide in 2002 as an alternative to regular cigarettes, e-cigarettes didn’t become easily available in the U.S. until late 2006. Now, the industry has grown from the thousands in 2006 to several million worldwide, with estimated 20,000 to 30,000 new e-smokers every week, according to Jason Healy, the president of e-cigarette maker Blu Cigs.

The FDA said the agency is reviewing the opinion and considering its next steps.

“We can now market our product the way we always should have been able to,” Matt Salmon, the newly tapped CEO of Sottera Inc., which markets NJOY-branded electronic cigarettes, said in an interview with The Associated Press. “This is plain and simple an alternative to smoking for committed, longtime smokers.”

Matthew L. Myers, president of the Campaign for Tobacco-Free Kids said in a statement that the decision will allow “any manufacturer to put any level of nicotine in any product and sell it to anybody, including children, with no government regulation or oversight at the present time.”

“This ruling invites the creation of a wild west of products containing highly addictive nicotine,” Myers said, urging the FDA to appeal the decision to the Supreme Court.

American Heart Association CEO Nancy Brown also voiced concern over the ruling.

“There is no scientific evidence that e-cigarettes are effective smoking cessation devices and, until they undergo rigorous evaluation by the Food and Drug Administration, they should be pulled from the marketplace,” she said in a statement.

In September, the FDA issued warning letters to several makers of electronic cigarettes or its components, saying the companies are violating the law with unsubstantiated health claims and poor manufacturing practices.

The FDA also has said that its tests found the liquid in some electronic cigarettes contained toxic substances – besides nicotine, which is itself toxic in large doses – as well as carcinogens that occur naturally in tobacco. Most e-cigarettes are imported from overseas.

However, some public health experts say the level of those carcinogens was comparable to those found in nicotine replacement therapy, because the nicotine in all of the products is extracted from tobacco.

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Pharmacy News: December, 9

City Council Approves Rezoning for Pharmacy

A blow to some homeowners in East Lansing fighting the construction of a CVS pharmacy in their neighborhood.

After a three hour public hearing last night, city council members voted in favor of rezoning so that the pharmacy can be built.

Homeowners near Coolidge and Lake Lansing are against the city tearing down an empty building that was last used by Blue Cross Blue Shield two years ago, and turning it into a pharmacy.

They say they’re concerned about the extra traffic to the area once the pharmacy opens.

The vote to rezone the building passed three to zero.

Woman charged in pharmacy holdup

A Halton Hills woman has been arrested and charged with a gunpoint robbery at a Brampton pharmacy.
Debbie Meaniss, 35, has been charged with one count each of robbery and wearing a disguise in connection with the February 8 holdup at Conestoga Pharmacy.
Peel Regional Police obtained an arrest warrant for Meaniss on Sept. 29, and she was arrested by Hamilton police Saturday.
Police say a heavyset woman with a gun approached two female employees at the Bovaird Drive pharmacy and demanded drugs. She escaped with approximately $1,000 worth of narcotics.
No shots were fired and one was injured, according to police.
• • •
Halton Police are investigating the theft of two fully loaded trailers from Truck Town Terminals on Steeles Ave. Saturday evening.
One of the trailers was full of industrial water heaters and the other one cans of Beefaroni. Police did not have an estimate of the value.
The trailers are 53 ft., light blue, and stolen from a compound between 8:45 and 8:55 p.m.

Closing of Forer Pharmacy Inspires Reflections on State of Local Businesses

The last independently owned and operated pharmacy in Princeton closed quietly last week, with the awning reading “Forer Pharmacy” removed by the next day. A sign in the window explained that it had been sold to the national pharmacy chain CVS.

While the circumstances of the closing of Forer do not fit with the usual pattern of big box or national chains crowding out smaller independently-run operations with limited resources, the closure of another independent business highlighted the struggle faced by local merchants, particularly retailers.

Clothier Nick Hilton, who owns and operates Nick Hilton Princeton on Witherspoon Street, and is also the founder of the independent merchant organization Hometown Princeton, explained that business owners are “really concerned with preserving the special nature of the Princeton community, and making it more appealing.”

“We’re all looking out for our businesses, but there is a certain ecological and environmental sensitivity to [the Buy Local movement] too,” Mr. Hilton suggested, emphasizing that “local independents are unique kinds of retailers. Take Forer Pharmacy. It was near the hospital and people could go there directly to have their prescriptions filled.”

The personalized aspects of local independent businesses, and the friendships that develop around them, are something that larger, more impersonal national chains can’t provide, according to Mr. Hilton.

In selling the business he and his twin brother Ira have operated over the past four decades, Mel Atlas of Forer Pharmacy said that the most difficult part of parting with the store is “giving up all the relationships you’ve built up over 40 years.”

Describing saying goodbye to his customers as “heart-wrenching,” Mr. Atlas said that in the last days Forer Pharmacy was open many clients stopped by. “There were a lot of tears and a lot of hugs. We’ve had customers for 30, 35, 40 years.”

Mr. Atlas acknowledged that CVS Pharmacy had approached the brothers in the past to inquire about purchasing the business. “We had many other potential buyers as well, and we felt that we wanted to end our era of association with the pharmacy.

“Forty years is enough time to put into any business. It’s been hard over the past year or two to come to the decision [to sell]. Business was still good, and we could have stayed …. Still, standing on your feet all day is tiring, and enough is enough. It was time to give it up,” Mr. Atlas conceded.

While the business was sold to CVS, the building remains in the possession of Mel and Ira Atlas. “There’s not a lot of certainty when it comes to that,” Mel Atlas said as to whether he was planning to sell or rent the building, though he admitted that his current inclination is to sell it “unless I got somebody to lease it and I knew that they would be an ongoing business.”

Currently, they are in the process of “weighing the decisions,” with Mr. Atlas commenting that they were in no rush, though he expected conclusions to be reached within the next three to six months.

The two brothers’ relationship with Forer Pharmacy began just prior to 1970, when Ira worked for the original owner, Marv Forer. About six months after Ira left his job there, he got a call from Mr. Forer saying that he was interested in selling the store. The brothers finalized the deal and within six months had also purchased the building, Mel said.

Though the closure is bittersweet, Mel Atlas admitted that “all good things come to an end, and it was time. I know it was the right time to do it.”

Mr. Hilton is hoping that community support for local independent businesses remains strong and grows stronger. “We have worked really hard to convince people they can find what they need in town … we don’t compete with local people, we compete with chains and internet stores.”

“If I want something special, unique and different, I go to those kinds of [independent] stores. That’s what we’re fighting to keep alive,” he added.

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Pharmaceutical news: December, 07

“Modern and Traditional Forms of Effective Pharmaceutical Marketing” and Other New Research Reports by PMR Published at MarketPublishers.com

LONDON – Market Publishers Ltd informs that new in-demand market research reports by PMR have been added to its catalogue.

Modern and Traditional Forms of Effective Pharmaceutical Marketing. Based on the Survey of 350 Doctors. The report is based on a survey conducted among 350 medical doctors of seven specializations: paediatrics, general practitioner/family medicine, gynaecology, neurology/ psychiatry, cardiology, pneumology and oncology. The report provides information to pharmaceutical companies on the most effective forms of communication with medical professionals and contains valuable estimations and evaluations of major metrics and issues …

Telecommunications Market in Poland 2010: Development Forecasts for 2010-2014. The report gives a comprehensive overview of the telecommunications market in Poland. It discusses the main events, trends and directions of development in the coming years. In addition to the data for the telecommunications market as a whole, the report analyses all the key segments, namely mobile telephony, fixed-line telephony and ISP. Each chapter offers most recent data on individual segments of the market and presents profiles of the largest players. The report also gives forecasts of the key market indicators and analyses growth opportunities …

Grocery Retail in Central Europe 2010 Poland, Czech Republic, Slovakia, Hungary and Romania: Market Analysis and Development Forecasts for 2010-2012. The global crisis has affected economies within Central Europe differently and on various levels, creating both difficulties and prospects for the businesses. The report presents an accurate, detailed snapshot of the retail food market in Poland, Czech Republic, Slovakia, Hungary and Romania. Along with consumer and retailer profiles, a descriptive statistics concerning the structure and size of the market were analyzed. Macroeconomic overview of the region, market size, composition of the grocery sector and modern shopping centres areas, major distribution channels and profiles of the main market players are reviewed …

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Pfizer’s new boss Ian C Read: the most powerful British executive in the global pharmaceutical industry

However, when Pfizer, the world’s largest pharmaceutical company, promoted Scottish-born Ian C Read to its top job, it’s arguable that Witty lost the distinction. Unlike Witty, who also spent some of his career in the US, Read now has US citizenship.

The move caps a steady but remarkable ascent for Read, who joined Pfizer four years after graduating with a science degree from Imperial College in London in 1974. He also qualified as a chartered accountant. Pfizer’s shareholders, who have had to stomach a 35pc decline in the company’s share price over the past four years, will want to know how Read can blend spreadsheets and science into a brew that puts the share price back on track.

Being described as someone with a long relationship with drugs is not usually a compliment, but the analysts covering Pfizer seized on his experience as a virtue. “I think Ian will be able to talk more deeply and coherently about Pfizer given his many years of experience and his long background in the drug industry,” said Tim Anderson, at Sanford C Bernstein.

Brunei On Track To Have Its First Halal Certified Pharmaceutical Plant

Bandar Seri Begawan – Marking a start of a new chapter in Brunei Darussalam in terms of diversifying the economy, the Minister of Finance II at the Prime Minister’s Office, Pehin Orang Kaya Laila Setia Awang Haji Abdul Rahman bin Haji Ibrahim, yesterday officiated a ground breaking ceremony for the construction of Vivapharm (Brunei), the Sultanate’s first Halal and GMP-certified (Good Manufacturing Practice) manufacturer of pharmaceutical and nutraceutical products in Lambak Kanan (East) Industrial Estate.

In Vivapharm (Brunei), the pharmaceuticals will not only get `CGMP’ licences, as well as certifications from FDA, Health Canada, and NSF, but more importantly, the Brunei Halal Brand. By obtaining this certification, it will help Vivapharm (Brunei) products get into Muslim markets.

Viva Pharmaceutical Inc, Aureos Capital and a group of local investors have committed to invest in Vivapharm (Brunei).

The total investment requirement for Vivapharm (Brunei) will be in the range of B$26 million – out of which Viva Pharmaceutical Inc, Aureos and a group of local investors will commit almost B$15 million.

The remaining funding will be from a local financial institution.

According to Mr Jason Ko, a representative of Kukoh Bersama, it will take between one and oneand-a-half years for construction to be completed. Once it’s ready for operations, Vivapharm Canada will provide formal training programmes, as well as on-the-job training to staff of Vivapharm (Brunei).

Bruneian staff will also have the opportunity to undergo training in Canada.

Through this, Vivapharm hopes to pass on the technical knowledge to Bruneians so as to benefit the Sultanate as a whole.

This venture will also create skilled and semi-skilled jobs in a new industry, in which Brunei aims to become a world leader in manufacturing Halal pharmaceutical products.

Alongside its manufacturing activities, Vivapharm will also invest in Research and Development (R&D), particularly those that are focused on developing new drugs and advanced technologies based on the local flora and fauna found in the “Heart of Borneo”, a mountainous region of almost 85,000 square miles which is covered with equatorial rainforest in the centre of the island

Following the footsteps of Viva Canada, Vivapharm (Brunei) will follow its strategy in investing in R&D.

Vivapharm (Brunei) also intends to work with a local university to provide students the opportunities to pursue a career in the pharmaceutical industry.

Once this project is up and running, Brunei will be the first country to issue guidelines on the production of Halal pharmaceuticals, including the use of alcohols and animal products.

According to Mr Ko, Vivapharm (Brunei) will market Viva’s own brand name products. Vivapharm will focus on the Southeast Asian region, especially in Malaysia and Indonesia.

It also hopes to increase its market share in the Middle East, Asia Pacific, Western Europe and USA.

Mr Ko has high hopes for Vivapharm (Brunei), as the Sultanate will have a “great opportunity” to make this new industry as the “second major industry” after the nation’s oil and gas industry.

This would greatly diversify Brunei’s economy, he added.

Vivapharm, a sub-franchise of Viva Pharmaceuticals Incorporation was established in April 1994 and is now one of the largest GMPcertified pharmaceutical and natural health product manufacturers in British Columbia, Canada.

Viva Pharmaceuticals also obtained GMP & CGMP licences and has NSF certification and Halal certification.

During yesterday’s groundbreaking ceremony, representatives of Brunei Industrial Development Authority (BINA) and Kukoh Bersama signed a lease agreement.

Signing on behalf of BINA was Pengiran Haji Tajuddin bin Pengiran Haji Salleh, while Kukoh Bersama was represented by Pengiran Haji Adanan bin Pengiran Seri Indera Pengiran Haji Ismail.

It was witnessed by Awang Haji Metassan and Mr Ko. — Courtesy of Borneo Bulletin

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Air flow during ventilator

Air flow during ventilator-supported speech production. The black circles represent occlusions, and the gray circle represents higher-than-usual impedance. During inspiration, air flows both toward the lungs and through the larynx. During usual expiration, almost all air flows toward the ventilator. This is because the impedance of the ventilator pathway is much lower than that of the laryngeal pathway during speech production. During expiration with PEEP, the impedance of the ventilator pathway is higher than usual so that more air flows through the larynx. During expiration with a one-way valve, all air flows through the larynx. Adapted from Hoit et al.

Dually for each subject by briefly testing a range of levels buy Viagra in Canada online. The level that was most comfortable for the subject was used for the study. It was not possible to test all subjects on all interventions due to time limitations imposed by nursing staff schedules, subject fatigue, subject preferences (eg, rejection of lengthened Ti), and the fact that several subjects also participated in additional interventions not reported here.

With each condition, we recorded several breaths with nose and mouth closed (except in the four subjects whose usual condition included use of a one-way valve). The subject read a paragraph aloud, and then was asked “How does your speech sound?” and “How does your breathing feel?” The subject responded by using a rating scale (— 2 = much worse than usual; — 1 = slightly worse than usual; 0 = usual; + 1 = slightly better than usual; + 2 = much better than usual).

The speech signal was sensed by a head-mounted microphone. Pt was sampled using a polyethylene catheter inserted through the sealed port of a swivel adapter and advanced through the tracheostomy tube to a point just within its proximal end. The catheter was connected to a transducer and amplifier. Tidal Pco2 was sampled from the common ventilator line and measured with a clinical monitor. Noninvasive measure of arterial oxygen saturation (Spo2), heart rate, and noninvasive BP were monitored continually. A digital audiotape recorder was used to record the speech signal, Pt, end-tidal Pco2, and ventilator flow.

Ten objective measures were computed. Auditory perceptual analysis was conducted by five listeners, all of whom were certified speech-language pathologists. Each listener was presented pairs of speech samples, one with the subject’s usual ventilator settings and one with an intervention.

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