Health Matters | Patients and patents — the double-edged sword

This week in health: deaths by water, male infertility crisis and a doctor’s quest to aid victims of Manipur ethnic violence.

Updated - July 26, 2023 07:19 am IST

Published - July 25, 2023 11:02 am IST

A file photo of lifesaving drug-resistant tuberculosis (DR-TB) drug bedaquiline. Image for representational purpose only.

A file photo of lifesaving drug-resistant tuberculosis (DR-TB) drug bedaquiline. Image for representational purpose only. | Photo Credit: The Hindu

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The most raucous discussions on health care are often centred around costs — costs of treatment, drugs, and hospitalisation being so exorbitant that paying for healthcare impoverishes even one initially able to pay for treatment. But over the course of taking care of oneself, impoverishment, or depletion of resources, is more often likely than not, leading to patients discontinuing treatment regimens. The most obvious fallout of this is mortality and morbidity of the patients themselves, but also in a large public health sense, this kind of behaviour can lead to deadly drug-resistant strains of pathogens gaining ground. That the costs of research and development of drugs are very high, and therefore, will have to be passed on to the customers in order that the pharmaceutical industry remains viable, is often the excuse. Leading us to the classic conundrum: when demand spurs supply but somewhere in the process, commercial interests put the product out of the reach of the target group. There is nothing as tragic as a solution being available within sight, but remaining beyond grasp. And, what Gandhi said about there being enough for everyone’s need, but not for their greed.

In fact, the Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS Agreement) was evolved in order to offer interventions that relate to the standards of patent protection accorded to inventions in pharmaceuticals. Under the TRIPS Agreement, patent rights are not absolute but can be subject to limitations or exceptions. The World Trade Organisation lists three types of exclusions: inventions the prevention of whose commercial exploitation is necessary to protect ordre public or morality, including to protect animal or plant life or health; diagnostic, therapeutic and surgical methods for the treatment of humans or animals; and certain plant and animal inventions. Under the TRIPS Agreement, the available term of protection must expire no earlier than 20 years from the date of filing the patent application.

More recently, the expiry of the primary patent for the critical, lifesaving drug-resistant tuberculosis (DR-TB) drug bedaquiline made headlinesBindu Shajan Perappadan reported that, as Johnson & Johnson’s 20-year primary patent on bedaquiline expired in a large number of countries, including India, on July 18, Médecins Sans Frontières reiterated its call for the U.S. pharmaceutical corporation to publicly announce that it will not enforce any ‘secondary’ patents for the drug in any country with a high burden of TB. Moreover, it should withdraw and abandon all pending secondary patent applications for this critical drug everywhere.

In good measure, the current position has to do a lot with the ‘pre-grant opposition’ petition that was filed by a patient group and two TB survivors — Nandita Venkatesan from India, and Phumeza Tisile from South Africa. As a result of their legal challenge, in a landmark decision before World TB Day, the Indian Patent Office rejected the U.S. corporation J&J’s secondary patent which would have extended its monopoly for four more years. In this articleLeena Menghaney and Vidya Krishnan explain the impact of this patent expiry on costs and availability in the Indian scenario.

More on the topic of affordability and healthcare funding, a study by a team at IIT-Madras found that conditional funding of health projects has a positive impact. R. Sujatha reports on the study which showed that whenever the States received funding only if they complied with the Central Government’s requirements, they increased investments in primary health care. An unexpected health funding spin-off from the pandemic is corporates beginning to offer cover for outpatient department visits to their employees. Maitri Porecha notes how in a comparative study, there was a definite increase in the number of companies providing OPD benefits in 2023. Of the 251 IT, manufacturing, pharma, engineering, financial and other companies studied, only 40 were providing out-patient department (OPD) benefits in 2019. However, in 2023, this number had grown to 85 companies.

Last week, there was much discussion on the medical education sector in India. That’s when we also discovered that 10%-55% of BDS and MDS seats fell vacant across India for over five years, as per data from the Dental Council of India. The lack of job and growth opportunities, low pay, and little awareness of mouthcare in tier-2 and tier-3 cities was resulting in the demand for graduate and post-graduate degree courses in dentistry. In a follow-up to the National Testing Academy cancelling the National Exit Test for MBBS students for the year, AIIMS also cancelled the mock NExT exam scheduled for Friday (July 28). With 40% of the districts having no nursing colleges, the Health Ministry urged the States to correct regional disparities. It might not come as a surprise to those following medical and allied courses education in this country that 42% of the nursing colleges are in five southern States.

There are always the infectious diseases and non-communicable diseases to deal with, inevitably linked with lifestyle issues and climate change. We have said this before, in an Indian context, but last week, it was the World Health Organisation warning that cases of dengue fever could reach close to record highs this year, partly due to global warming benefiting mosquitoes that spread it. Dengue rates are rising globally, with reported cases since 2000 up eightfold to 4.2 million in 2022, the WHO said. Did you know that environmental contaminants have an impact on the male fertility crisis? Do read this article by Liana Maree, Daniel Marcu, and Shannen Keyser. They write that concern is rising about substances such as per- and polyfluoroalkyl substances, nanomaterials and endocrine-disrupting compounds, present in personal-care products such as soaps, shampoos and hair sprays, as well as food wrap, water bottles and many other items.

Sadness, sleeplessness, stress, and anxiety top mental health concerns shared on Tele MANAS, the toll-free digital arm of the Centre’s District Mental Health Programme, available in 20 languages. Not helping our populations on the brink of an NCD epidemic any. Stress, lack of sleep and anxiety are not what the doctor ordered, in order to keep metabolic disorders at bay. Also, as a run-up to World Drowning Prevention Day on July 25, Zubeda Hamid discovered that death by water could be prevented with the State and individuals taking adequate precautions.

Will the world miss its Zero Hunger Sustainable Development Goal? If the Global Report on the Food Crises (GRFC) 2023 is anything to go by, the world is more likely to miss its 2030 target to eliminate hunger which is inevitable. While an intervening pandemic, a war, and unfavourable governmental policies have impeded the reduction of food insecurity, the GRFC has offered some solutions as well, I write here.

And how much technology is too much technology? For our interesting tailpiece, do read this story, “Pandemic effect: Schools notice drastic increase in tech dependency among young children”, writes Jahnavi T. R.

From the Health pages

You might want to check out the following stories:

A new drug prescribed for Alzheimer’s patients, donanemab, was far from promising a cure but among those in the earliest stages of the disease, it significantly slowed cognitive decline, writes Jacob Koshy.  

More on the sugar-substitute carcinogenic property story here from Aju Mathew.

Vipin M. Vashishtha and Puneet Kumar provide yet another angle to the role of oral polio virus vaccine in disease transmission.

 Sudden deaths of youth have been reported after COVID-19: Health Ministry in Lok Sabha.

 Medical device industry asks Health Ministry to reconsider new regulatory Bill.

Further, continuing our offering of regional stories from across the country. Pick your region and read on:

Andhra

Andhra Pradesh sees 27 deaths due to rabies in last 18 months, writes Tharun Boda.

Over 1.8 lakh women were screened under the Arogya Mahila Scheme in 20 weeks.

Delhi

For sexually abused children, the road to rehab is long, says Samridhi Tiwari.

Karnataka

Nothing like the odd ones that catch our attention: Bengaluru doctor treats a senior citizen whose hand ‘stole’ blood from brain, Afshan Yasmeen writes.

Survey finds 41% of respondents in Bengaluru consume foods with artificial sweeteners.

Kerala

Project X aims to impart sexuality education for school students in the capital district of Kerala, R.K. Roshni writes.

Tamil Nadu

Serena Josephine M. writes on the complete Makkalai Thedi Maruthuvam experience in Tamil Nadu.

Tamil Nadu to roll out cancer screening for women on pilot basis.

Lack of access to health care can be fatal, as this tribal’s family in Vellore found out.

Telangana

Hyderabad doctor extends lifeline to victims of Manipur ethnic violence, Siddharth Kumar Singh writes.

V. Geethanath reports that scientist moots the installation of wastewater monitoring in STPs as a part of OneHealth and pandemic preparedness.

Experts discuss parental diagnosis in preventing thalassemia.

As always, do put us on your radar, as we bring more health content your way. Get more of The Hindu’s health coverage here.

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