Wednesday 28 November 2012 07.00 GMT Pharmaceutical companies are doing more to help people in developing countries obtain the drugs they need, according to the latest Access to Medicines Index.Big Pharma appears to have concluded, after years of bad publicity and allegations that it was greedy and uncaring in pursuit of profit, that it needs to change its practices in the developing world – or at least public perceptions.While British drugmaker GlaxoSmithKline (GSK), whose chief executive Sir Andrew Witty has announced moves to increase access to medicines in the developing world, continues to top the league table, its lead on the rest has shrunk. Two other major pharmaceutical companies, Johnson & Johnson and the vaccine manufacturer Sanofi, are now close behind.The index ranks 20 leading pharmaceutical companies and is published every two years by the Netherlands-based non-profit Access to Medicines Foundation. It has become an authoritative guide, with input from the World Health Organisation, governments, universities, NGOs and institutional investors.Drug companies are scored on a range of measures, from their willingness to discount prices in poor countries, to research on neglected diseases of poor people to lobbying, transparency and conduct in clinical trials.This is the third index and it finds a much greater focus on drug access within drug companies – where it is now often an issue for the board."This year's index shows that companies are becoming more organised internally in their approach to access to medicine and that those who do this best tend to perform well across the other aspects we measure. The leaders are really raising the bar," said Wim Leereveld, founder of the index. "It's also clear that companies that do not continue to step up their efforts tend to be overtaken by their peers."Although there has been improvement and a greater willingness among companies to change their business practices, it is not yet enough. More companies are using tiered pricing – offering a discount for poorer countries – for a broader range of products, "but it is unclear whether the price reductions are enough to meaningfully increase affordability", says the report.Only five companies varied their pricing in 2010 but 12 did it this year. Yet they do not always disclose the full extent of the reduction nor take account of mark-ups by sales agents within a country. The best performer on tiered pricing is Gilead Sciences, which makes some of the leading Aids drugs. GSK has fallen to second place for a number of reasons, including reducing prices in fewer countries than Gilead.More companies are researching and developing medicines for diseases of poor countries. Some now have as much as 20% of their pipeline – drugs they are in the process of researching which one day will get to market – devoted to them.But there are concerns that Big Pharma is not demonstrating real influence over the private contractors it now increasingly uses to carry out drug trials in the developing world. No company is publicly transparent about all the Contract Research Organisations (CROs) it employs, says the report. The foundation says companies must ensure they hold these CROs to account for ensuring the wellbeing of volunteers in trials and conducting the trial scrupulously. Only four companies – Merck and Co, Sanofi, GSK and Eisai – provided evidence to show that they could and would use disciplinary measures to ensure CROs carried out trials in a safe and ethical manner."Access to medicine is a multi-faceted challenge and therefore responsibility for improving it lies with a number of different actors, but the pharmaceutical industry has a critical role to play. While the index shows it has made strides in many areas, companies that have sector-leading practices also show us there is more the industry can contribute," Leereveld said.
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