European Fiscal Collapse and Counterfeit Meds in Africa
One of the projects I’ve been working on for several years is the issue of counterfeit drugs in Africa and other under-developed worlds. A couple of years ago, I met with a former VP for Africa from GSK, who related one of GSK’s sting operations in Kenya: They followed a large shipment of AIDS meds that were unloaded at the airport in Nairobi, where bad guys exchanged them for counterfeit meds at a hangar at the airport, and the very same airplane went back to Europe with the real AIDS meds, to be sold on “the black market”. After the meeting, I thought of a question that hadn’t occurred to me in real time:
Why would there be a “black market” in Europe, which has socialized medicine?
European governments provide free health care to everybody… don’t they?
At a recent meeting, I received a tiny little hint of a Clue from a friend who is a senior executive with a large European pharmaceutical company… and who journalists would certainly describe as a reliable source.
The Clue: his company is owed about €900M from Italy and Spain and hasn’t been paid in 3 ½ years; Greece has been “paying” with Greek Bonds. Evidently there’s a law requiring this company to continue to supply these medicines, even though these governments have long since stopped paying for the goods.
So … how has society responded to this situation?
Given that companies are required to provide product w/o getting paid, are they likely to fill every “order” in a timely manner? Would you think some shipments might get delayed… perhaps not keep up w/ growing demand? The first law of Milton Friedman Economics would predict that when a government forces product to be sold unprofitably, after some period of time, shortages will be created.
What happens when the government induces a shortage of medicines?
If you had a patient in your office and knew that there was a shortage of medicines at the government-supplied pharmacy, but knew also that your good friend - call him Lime - had a reliable supply, wouldn’t you be morally bound to introduce your patient to Lime?
While I can’t prove it, given the lack of payment by Italy, Spain, and Greece, it seems likely that a black market for medicines should develop there – and will exist wherever there’s a health care system that can’t pay its bills or refuses to supply a product to its patients.
I won’t argue that this explains why AIDS is so prevalent in Africa, which hosts 54 of the most corrupt governments on earth. But the situation does beg the question:
Which is worse:
1) incredibly corrupt government typical of Africa or
2) incredibly incompetent government typical of Southern Europe?
Either way, the combination reminds me of that famous black and white movie, The Third Man, set in post war Italy when its society was even more chaotic…
… only the nemesis in that movie, Lime, has been replaced by unnamed government bureaucrats in Italy, Spain and Greece.
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Jul '11
Re: European Fiscal Collapse and Counterfeit Meds in Africa
Excellent post. Marriage is a death sentence for many women in Africa. As far as the meds, price controls and mandates are the inspiration for shortages. The poorer socialized countries have a thriving black market for all flavors of drugs and increasingly it is not of the heroin type. I did not know the mandate issue though, what a joke.
Jul '11
Re: European Fiscal Collapse and Counterfeit Meds in Africa
Early in the HMO world there gag orders placed on physicians, not paying them or fining them, if they mentioned non covered therapies to patients. An ethical dilemma you point out is to suggest something illegal yet is beneficial to your patient. Always put them first and you'll sleep well is my choice.
May '10
Re: European Fiscal Collapse and Counterfeit Meds in Africa
That is really interesting!
Setting up ethical dilemmas for doctors while paying them less... Perhaps that's why 85% of the doctors now practicing in the UK were trained outside of the European Union.
Dec '11
Re: European Fiscal Collapse and Counterfeit Meds in Africa
While I can’t prove it, given the lack of payment by Italy, Spain, and Greece, it seems likely that a black market for medicines should develop there – and will exist wherever there’s a health care system that can’t pay its bills or refuses to supply a product to its patients.
I'd also mention the decline of GlaxoSmithKline UK. (I'm sure our resident DocJay can explain how this underfunded company contributed to an international flu vaccination shortage.)
The public may continue to demonize Big Pharma, but I thank my lucky stars for Pfizer, Eli Lilly, and Johnson and Johnson of the USA. They are some of the few companies remaining with the cash flow to fund the excruciatingly expensive, yet critical R&D necessary to fight disease and extend lives.
Edited on May 19, 2012 at 3:12amApr '12
Re: European Fiscal Collapse and Counterfeit Meds in Africa
Yes,the UK lost its best doctors to the USA back in the sixties and so does Canada. There is a ceiling on how many hours you can work and get paid. My doctor friends in Canada guide their kids into the profession as it gives a good revenue stream as the govt in Canada does pay. As for why Africa has so much AIDS, government - or what government? - plays a far lessor part in peoples' lives. I grew up thinking business did schools, hospitals, roads, rescue, laws, etc. Govt was frightening and confiscatory and weird. I observed little moral structure around sexuality and marriage was something colonial. There were many " wives" and men were not expected to stick around. In fact, I did not see many marriages or intact families. Grandmothers looked after kids while women worked. Many new mums were 11 or 12 and that was in more sophisticated cities. There were multiple Dads to one woman's children but very few who I saw stick around. The intact family is constructed by the society and I do believe women need all the help they can get to have the father of her children stay with her.
Dec '11
Re: European Fiscal Collapse and Counterfeit Meds in Africa
Not in the private sector.
Nov '10
Re: European Fiscal Collapse and Counterfeit Meds in Africa
Indaba:
I grew up thinking business did schools, hospitals, roads, rescue, laws, etc. Govt was frightening and confiscatory and weird. I observed little moral structure around sexuality and marriage was something colonial. There were many " wives" and men were not expected to stick around. In fact, I did not see many marriages or intact families. Grandmothers looked after kids while women worked. Many new mums were 11 or 12 and that was in more sophisticated cities. There were multiple Dads to one woman's children but very few who I saw stick around. The intact family is constructed by the society and I do believe women need all the help they can get to have the father of her children stay with her.
A brilliant and disturbing summing-up of why marriage -- contra the desires of libertarians -- cannot be "privatized."
Dec '11
Re: European Fiscal Collapse and Counterfeit Meds in Africa
Robert Lux
Indaba:
The intact family is constructed by the society and I do believe women need all the help they can get to have the father of her children stay with her.
A brilliant and disturbing summing-up of...
the consequences of non-capitalist economies.
You're both missing the point. It's all about the ability to make the donuts.
Nov '10
Re: European Fiscal Collapse and Counterfeit Meds in Africa
EThompson:
Robert Lux
Indaba:
The intact family is constructed by the society and I do believe women need all the help they can get to have the father of her children stay with her.
A brilliant and disturbing summing-up of...
the consequences of non-capitalist economies.
You're both missing the point. It's all about the ability to make the donuts. · 6 hours ago
Habituation to virtue -- which most people learn in male/female marriage based family -- is the sine qua non to "making the donuts."
Jun '10
Re: European Fiscal Collapse and Counterfeit Meds in Africa
It's not complicated. Providers serve the paying client. If the paying client changes from privately-insured patient to national healthcare bureaucrat, then that's who they'll serve. If you want to continue getting the best care in the world, become a healthcare bureaucrat. Then you're covered either way.
Nov '10
Re: European Fiscal Collapse and Counterfeit Meds in Africa
"Nobody thinks in terms of human beings. Governments don't. Why should we?" --Harry Lime to Holly Martins, The Third Man.
Life imitates art.
Oct '10
Re: European Fiscal Collapse and Counterfeit Meds in Africa
My general rule of thumb is that as long as you're deemed a “customer” you will be well-treated and find a number of competitors vying for your business. The moment you become a “consumer”, “client” (in the welfare state sense of the word), “end user”, or member of a class “entitled” to services, you'll find yourself receiving shoddy service, abusive treatment, and deprived of any effective form of push-back.
The one form of feedback which always works is refusing one's patronage and taking your business elsewhere. Consequently, the top priority of the slavers is eliminating diversity in the marketplace in the interest of “efficiency”.
This ties into my comment yesterday about changing one's nationality. I've found few things as liberating as discovering that citizenship is an accident of birth and looking at yourself as a customer who can choose among places to live and passports to carry based upon their congruence with your own individual desiderata.
Mar '11
Re: European Fiscal Collapse and Counterfeit Meds in Africa
While it is always fun to pick on wealthy countries and the shortcomings of their state-mandated healthcare giveaways, HIV drug scarcity is really only a problem in Eastern European countries (especially Ukraine and Russia). In all likelihood, the stolen African ARVs were headed to the Ukraine, which has more HIV-positive citizens than France, Germany and the UK combined.
Of course, in many ways the drug shortage in Ukraine is also a government problem: there was a promise to provide free antiretrovirals to everyone with HIV, but corrupt bureaucrats diverted too much of the money along the way, leaving many patients helpless.
At several Europe-wide virology conferences I have attended, the issue of ARV shortages in Western Europe has never come up. However, given the financial crisis and the tendency of many governments to defraud their creditors through worthless bonds, this scenario may become real in the future.
Edited on May 19, 2012 at 9:05pmOct '10
Re: European Fiscal Collapse and Counterfeit Meds in Africa
Occasionally I wonder if my wife and I have been right in totally droping out of the medical system and educating ourselves for self treatment without drugs. Linda is a quadriplegic and 64 years old, I am 69. We have literally nothing to do with conventional doctoring. Linda self treats her very high blood pressure which she has had since childhood, and I simply take good care of myself.
Oh, and we both take God seriously and lead an extremely low stress lifestyle. Spent almost 10 years in third world countries as a missionary, and had some very narrow escapes from violence.
Life is good, and this thread makes it easier to maintain our commitment... to each other and to God.
Opting out is not as hard to do as it would appear.
Jan '12
Re: European Fiscal Collapse and Counterfeit Meds in Africa
Why would there be a black market in Europe, which has socialized medicine?
European governments provide free health care to everybody… don’t they?
Answer No. They say they provide the same health care to everyone.
85% of the doctors now practicing in the UK were trained outside of the European Union.
I'm not sure which UK you are talking about but I doubt it is true of the one I live in. What is the source for that statement?
Aug '11
Re: European Fiscal Collapse and Counterfeit Meds in Africa
In a somewhat related vein, the EUNavFor has attack helicopters to use against pirates around the horn of Africa, to protect shipping that bring pirated products from the far east to Europe, much of which is sold on the streets by illegal immigrants. It's a many-fold mess.
Mar '11
Re: European Fiscal Collapse and Counterfeit Meds in Africa
raycon:
Opting out is not as hard to do as it would appear.
Yes and no.
A good portion (although certainly not the majority) of the advance in lifespan over the last few hundred years has been through the containment of infectious diseases - the plague, smallpox, polio, measles, you name it.
While some infectious agents have been minimized through non-medical advances (such as sewage treatment), most have been stopped through vaccines, antibiotics, and/or epidemiology.
One reason it is possible for an individual like yourself to opt out of medicine today is because so many others have partaken both in the past and the present. If smallpox were still rampant, I doubt there would be many parents refusing to have their children vaccinated.
This isn't to say that many interventions aren't superfluous. But when it comes to contagious diseases, those who opt out are often profiting from those who stay in.
Jun '10
Re: European Fiscal Collapse and Counterfeit Meds in Africa
Mark Zdeblick:
. . . . his company is owed about €900M from Italy and Spain and hasn’t been paid in 3 ½ years; Greece has been “paying” with Greek Bonds. Evidently there’s a law requiring this company to continue to supply these medicines, even though these governments have long since stopped paying for the goods.
Taking goods without payment is known as theft. Requiring a person (or company) to produce under duress without payment is known as slavery. A system that mandates the above as a matter of law is known as a tyranny. Socialism in a nutshell: bureaucratic, corrupt, coercive, arbitrary, and eventuallty deadly.
Nov '11
Re: European Fiscal Collapse and Counterfeit Meds in Africa
Given the risk of iatrogenic disease, it seems to me that there is no completely safe choice, and which ever way you go you are going to wonder whether it was right. I think it is clear, though, that without a third-party payer system, or with only catastrophic medical insurance, we would all be inclined to take better care of ourselves and to do as much self-treatment as possible.
Oct '10
Re: European Fiscal Collapse and Counterfeit Meds in Africa
Mendel
One reason it is possible for an individual like yourself to opt out of medicine today is because so many others have partaken both in the past and the present.
...when it comes to contagious diseases, those who opt out are often profiting from those who stay in. · 1 hour ago
You are somewhat correct. Linda, for instance was paralyzed from the neck down by polio at age 18 months. She partially rehabbed back to total paralysis from the hips down, and used crutches until about 10 years ago, when it caught up with her. She is now a high functioning quadriplegic.
We do benefit from those who have gone before, but we spent almost 10 years working in countries where polio and other diseases have gone untreated. We know the costs well.
One of the costs we pay here in the West is that we have such a fear of death that we have robbed the process of it's dignity.
Death is simply moving on, if you are a Christian it is to a better place. Our hope is that God is true to His word. Death isn't something to fear, it is a release.