Pharmaceutical industry profits and cost to senior citizens' health

Full text

For personal use. Only reproduce with permission from The Lancet Publishing Group.
1950 THE LANCET • Vol 359 • June 1, 2002 • www.thelancet.com
CORRESPONDENCE
diseases have failed to ensure this
independence.
Peter Davies
Tuberculosis Research Unit, Cardiothoracic
Centre and University Hospital Aintree, Liverpool
L14 3PE, UK
(e-mail: p.d.o.davies@liv.ac.uk)
1 Schieppati A, Remuzzi G, Garattini S.
Modulating the profit motive to meet needs
of the less-developed world. Lancet 2001;.
358: 1638–41.
2 Leese J. Tuberculosis—a 19th century
disease in the 21st century. CMO’S Update
Oct 31, 2001: 4.
Rove beetles, which breed in the
marshy banks of the Nile and scavenge
tadpoles and carrion,3were provided
heaps of decaying frogs on which their
numbers could flourish. Thus arose the
third and fourth plagues, in which
“grievous swarms of insects invaded
Pharaoh’s palace and the houses of
Egypt”. Rove beetle swarms are
normally focal, which may explain why
the insects plagued the Egyptian
community but spared the
neighbouring Israelites.
Soon thereafter, “boils
[sh’chin]: boils or eruption) breaking
forth with blains [avahbu’ot]:
blisters or boils) on man and beast”
formed the sixth plague. Paederin-
induced blisters erupt 1–4 days after
exposure; thus, victims frequently do
not associate the beetles and skin
lesions causally and think of them as
separate events.
We propose that the third and fourth
plagues were an invasion of Paederus,
probably P alfierii, a blister-causing rove
beetle that lives in the Nile delta,3
whose population exploded under the
conditions of the first two plagues. The
swarm was localised to the humid Nile
delta area, affecting only the Egyptian
community, and the subsequent
outbreak of blisters, occurring several
days later, was perceived as a separate
event—the sixth plague.
*Scott A Norton, Christina Lyons
*Dermatology Service, Walter Reed Army
Medical Center, Washington DC 20307, USA;
and University of Washington School of
Medicine, Seattle, WA
(e-mail: Scott.Norton@na.amedd.army.mil)
1 Marr JS, Malloy CD. An epidemiologic
analysis of the ten plagues of Egypt.
Caduceus 1996; 12: 7–24.
2 Sendur N, Savk E, Karaman G. Paederus
dermatitis: a report of 46 cases in Aydin,
Turkey. Dermatology 1999; 199: 353–55.
3 Frank JH, Kanamitsu K. Paederus, sensu lato
(Coleoptera: Staphylinidae): natural history
and medical importance. J Med Entomol
1987; 24: 155–91.
4 Roberts JI, Tonking HD. Notes on an East
African vesicant beetle, Paederus
crebripunctatuts Epp. Ann Trop Med Parasitol
1935; 29: 415–20.
5 Todd RE, Guthridge SL, Montgomery BL.
Evacuation of an Aboriginal community in
response to an outbreak of blistering
dermatitis induced by a beetle (Paederus
australis). Med J Aust 1996; 164: 238–40.
Blister beetles and the ten
plagues
Sir—Several interpretations of the
biblical ten plagues (Exodus
7:14–12:30) postulate that the insects
of the third and fourth plagues gave rise
to the boils of the sixth plague.1The
notion that these were arthropod-borne
epidemics, such as bubonic plague,
trypanosomiasis, or leishmaniasis, is
unlikely because the Israelites probably
would not have escaped such widely
transmitted diseases. Reports of
invasions of blister-inducing rove
beetles in southwest Asia2suggest a
novel explanation.
Many rove beetles (Paederus spp,
Staphylinidae) have a toxic haemo-
lymph called paederin that causes
painful necrotic blisters when a beetle is
crushed on the skin.3Rove beetle
populations are generally small but
under the right environmental con-
ditions, they can reach spectacular size.
At night, beetles are attracted to lights
and commonly descend on inhabited
areas, blackening walls.4The ensuing
vesication can injure thousands of
people and has forced the evacuation of
entire communities.3–5
The first two plagues may have
produced ideal conditions for massive
breeding of Paederus. In the first plague,
“the water of the Nile turned to blood”,
probably because of a bloom of toxic
phytoplankton (a red tide).1The anoxic
conditions in the river killed the fish
and forced “frogs onto the land of
Egypt”, causing the second plague.1
Pharmaceutical industry
profits and cost to senior
citizens’ health
Sir—The Japan pharmaceutical industry
is immensely profitable, enjoying a
current rate of return on investment that
is more than twice the Japanese average.
The cost of medical treatment in Japan
has been forced up by the cost of drugs,
which is the highest in the world—up to
30% of a total medical bill.1Meanwhile,
health costs are rising by 4–8% per year
for the elderly, whereas revenues are flat.
Government advisers have warned
that this economic situation will
push the medical-insurance system into
bankruptcy by 2003.2Further realign-
ment is predicted for the pharmaceutical
industry in the wake of the government’s
decision to cut the price the national
health system pays for prescription
drugs.
A decision to cut prices by an average
6·3% will cut nearly ¥400 billion off
annual industry revenues. Japan’s
Ministry of Health, Labour and Welfare
announced the revision in drug
reimbursement prices under the national
health insurance system for the fiscal
year 2002, beginning April 1. However,
the reduction is unlikely to lead to a
substantial fall in cash flows at the
companies, according to Standard and
Poor’s Corporation, the USA-based
credit-rating agency.
The pharmaceutical industry fiercely
guards its patents, and it has been aided
by the World Trade Organisation’s
agreements on intellectual property
rights, which include the right to
exclusively market a patented drug for at
least 20 years.
Japan has one of the lengthiest drug
testing and approval procedures in the
world. Outsourcing of clinical research
to overseas companies has been a viable
option since 1998, when regulations
were eased to allow drug makers to seek
approval for medicines clinically tested
overseas, provided additional tests are
done in Japan. Therefore, drug firms in
Japan are outsourcing more clinical
testing to research institutes in the USA
and Europe, where regulations are
looser and costs are lower.
Meanwhile, the Japanese government
is planning to increase hospital costs and
raise medical fees by 10% overall for
senior citizens. Pension payments to
senior citizens in Japan are among the
lowest in the industrial world, whereas
medical expenses are highest, hence the
only freedom the free market will offer
to senior citizens is the freedom to die
without treatment even if the cost of
drugs is reduced now.
We received financial assistance from the Japan
Society for Promotion of Sciences.
*E B R Desapriya, Iwase Nobutada
Institute of Social Sciences, University of
Tsukuba, Tsukuba 305-8571, Japan
(e-mail: desapriya@hotmail.com)
1 Suzuki R, Ikeda M, Karmi M, et al. Japanese
physicians and public respect. Lancet 2000;
356: 598–99.
2 Watts J. Japan’s new Prime Minister squares
up to health-care crisis. Lancet 2001; 357:
1509.
DEPARTMENT OF ERROR
Use of localised intracoronary
␤
radiation in
treatment of in-stent restenosis: the INHIBIT
randomised controlled trial—In this Article by
Ron Waksman and colleagues (Feb 16, p 551),
the second sentence of the Summary Findings
should have been: “24 (15%) patients in the
radiated group had the primary safety endpoint
of death, myocardial infarction, or repeat target-
lesion revascularisation over 290 days,
compared with 51 (31%) in the placebo group
(difference 16% [95% CI 7–25], p=0·0006).”