India-UK FTA may tighten screws on Generic drugs. Britain doing Big Pharma Bidding?


Several international organisations working to improve people’s access to medicines have written to the UK government protesting against provisions in a proposed India-UK FTA after the chapter on intellectual property was leaked. The provisions related to pharmaceutical IP could prevent India from making affordable generics on which the National Health Service (NHS) of the UK and several other countries depend.  India’s ability to produce generics is crucial not only to the Global South but to the UK too.

Four out of five drugs used in the NHS are generics and a third of these are produced in India. So about 25% of the drugs in the NHS come from India. Between 2011 and 2016, the NHS started to experience a crisis in the amount of money it was spending on new, very expensive drugs. The amount the NHS spent rose in those years by £3.8 billion. That is more than twice the total NHS deficit at that time – £1.85 billion. The crisis was so severe that the NHS began to look for ways to save money, including importing more generics. It worked.

International non-profit calls upon calls upon India to stay vigilant and asks the U.K. to withdraw intellectual property proposals.

The proposals on intellectual property (IP) rights in the draft India-United Kingdom Free Trade Agreement (FTA) will hurt the global supply of generic medicines, Doctors Without Borders (Médecins Sans Frontières or MSF) warned on Wednesday. In a press note, the international organisation said low medicine prices help save lives in vulnerable communities across the world but the intellectual property chapter of the India-U.K. FTA contains “harmful IP provisions”. The IP-related chapter, leaked on October 31, showed that the controversial provisions tabled by the U.K. to “tighten the screws on producing, supplying and exporting affordable generic medicines from India”.

“Given the disastrous consequences, this leaked IP chapter could have on the global supply of generic medicines, the U.K. government should withdraw it completely. India should stay vigilant and not allow barriers to affordable medicines to be written into FTA negotiations,” Leena Menghaney, South Asia head of MSF’s Access Campaign, said. 

U.K.-India trade talks continuing

In a “Fact Sheet”, MSF has argued that the demand for “harmonisation” of Indian patent law with the U.K.’s laws will lead to dilution of important provisions in the Indian patent system that are necessary for manufacturing generic medicines and vaccines.

“Article E.10 of the leaked IP chapter stipulates that both parties “shall not” make patent opposition proceedings available BEFORE the grant of a patent. In effect, this provision applies only to India as the U.K. does not have a pre-grant opposition system – this goes directly against the current Indian patent law, which allows patent opposition proceedings both before and after the grant of a patent,” the MSF said in its observations on the IP provisions.

MSF pointed out that under the proposals from the U.K., even treatment providers could be subjected to legal actions for prescribing generic medicines for which India is one of the largest manufacturing hubs. MSF said that the IP provisions brought up by the U.K. opened up possibilities for “excessive enforcement” that are likely to create difficulties for both Indian pharmaceutical companies as well as the legal set-up. 

MSF highlighted that another problematic provision is Article J.11 of the leaked IP chapter. Under this provision, Customs officials could block legitimate medicines from leaving India for other developing countries if a multinational pharmaceutical corporation was to claim that their patents were being infringed upon by the Indian product. “Furthermore, Article J.5 and J.7 prescribe how courts should adjudicate IP disputes, which could impact [Indian] judicial discretion,” MSF said.

A British government spokesperson said they would not comment on the “alleged leaks” and will only sign “a deal that is fair, reciprocal, and ultimately in the best interests of the British people and the economy”.

“The U.K. and India are negotiating an ambitious Free Trade Agreement that will boost our current trading relationship, already worth more than ₤24 billion last year,” the spokesperson told The Hindu.

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How to Reduce Social Media Addiction-Digital Minimalism


         The Demons of social media and online gaming  has rewired the people’s mind to live life and  remain in virtual world. The chaos and turmoil in the society can be linked to social media that exploits the deep wired craving of masses to know more about the “realities”. Once a curiosity  is fired, each one at social media starts feeding something or other.   In the mad game of TRP’s, clouts and engagements, these players cross ethical lines and create rifts. They literally hunt and scavenge news items that suit their narrative. They embellish it with more provocative words and share it with their name hoping to drive more engagement Conspiratorial and alarmist thinking is likely to keep people glued to social media.

     Covid-19 pandemic worsened addiction to the internet among children. The footfall at psychiatric out-patient departments in hospitals, especially those offering help to kids hooked to the net, be it for online gaming, chatting with friends or sharing videos, offers a glimpse of the problem.

Digital Minimalism- break free from “internet compulsions”

                                       
     Freedom, Cold Turkey, RescueTime, Toggl, StayFocusd, FocusMe, SelfControl, AntiSocial… They are not random words pulsed together in a blender, but names of some of the top apps that, ironically, help you stay away from your digital addictions. As Thakur said in Sholay, “loha lohe ko kaat-ta hai”, so now we need apps to stay away from apps. This farcical situation hides a deeper reality – too many of us are spending too much time online. So, amid the launch of 5G and other high-speed tech, a growing army of people doesn’t want to be addicted to social media and googling. They aspire to live frugal, almost ascetic, digital lives without completely switching off from the internet. It’s a trend called ‘digital minimalism’, and it is different from a ‘digital detox’ where you unplug completely. To illustrate, detox is what Mohityanche Vadgaon village in Maharashtra’s Sangli district does. A siren goes off at 7pm, and residents put their electronic devices away for 90 minutes. Children are encouraged to read while the older people meet and chat.

Digital minimalism, however, does not require complete withdrawal. Coined by author Cal Newport, it is a way of using technology in which you focus your online time on a few carefully selected tasks that strongly support the things you value. It advises against excessive use of gadgets.

Digital Minimalism- break free from “internet compulsions”

       Digital minimalism is based on three tenets: clutter is expensive, optimization is critical, and intention is satisfying. The objective is that the usage should be intentional and controlled for a limited period of time. And the apps mentioned above are meant to stop you from jumping from one attention-diverting push notification to another. They can block other apps from operating, create blocklists, schedule apps to run only during a specific time of the day, and alert you about the excessive time spent online.

       This philosophy is being discussed now, especially after the pandemic when people began spending more time online, adding that children aged 13-18 years have become more prone to digital addiction since the pandemic. The parents are taking their children to counsellors as they have become addicted to screens and feel isolated and tense when they have to interact with people in the real world. For them, online networking is secure and simple.” He advised gradually introducing such children to digital minimalism, to reduce their reliance and time spent on digital platforms. He also said it is critical for parents and adults to see if those who are addicted to digital devices have any anxiety issues. Because digital addiction has been observed in people who already have anxiety issues, these issues must be addressed first.  WHO has classified excessive use of the internet and mobile phones as screen addiction, and provided a set of guidelines. There is certainly a 50% increase in screen time addiction cases post-pandemic, we should be more concerned about the changes that will occur with advancements, like the metaverse.  Need to first introduce minimalistic practices, and then, in some cases, recommend mild medication to help people break free from their “internet compulsions”.

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Travel Associated Infections & Diseases


Depending on the travel destination, travellers may be exposed to a number of infectious diseases; exposure depends on the presence of infectious agents in the area to be visited. The risk of becoming infected will vary according to the purpose of the trip and the itinerary within the area, the standards of accommodation, hygiene and sanitation, as well as the behaviour of the traveller. In some instances, disease can be prevented by vaccination, but there are some infectious diseases, including some of the most important and most dangerous, for which no vaccines exist.

As many of such diseases are infections, general precautions can greatly reduce the risk of exposure to infectious agents and should always be taken for visits to any destination where there is a significant risk of exposure, regardless of whether any vaccinations or medication have been administered.

Modes of transmission and general precautions

The modes of transmission for different infectious diseases are diverse: 

  • Foodborne and waterborne diseases transmitted by consumption of contaminated food and drink. 
  • Vector-borne diseases transmitted by insects such as mosquitoes and other vectors such as ticks.
  • Diseases transmitted to humans by animals (zoonoses), more particularly through animal bites or contact with animals, contaminated body fluids or faeces, or by consumption of foods of animal origin, particularly meat and milk products. 
  • Sexually transmitted diseases passed from person to person through unsafe sexual practices.
  • Bloodborne diseases  transmitted by direct contact with infected blood or other body fluids
  • Airborne diseases involving droplets and droplets nuclei. Droplet nuclei <5 µm in size are disseminated in the air and breathed in. These droplet nuclei can remain suspended in the air for some time. Droplet nuclei are the residuals of evaporated droplets. Droplet transmission occurs when larger particles (>5 µm) contact the mucous membranes of the nose and mouth or conjunctivae of a susceptible individual. Droplets are usually generated by the infected individual during coughing, sneezing or talking. 
  • Diseases transmitted via soil include those caused by dormant forms (spores) of infectious agents, which can cause infection by contact with broken skin (minor cuts, scratches, etc). 

General precautions to prevent infections are outlined in the Chapter 5 of the international travel and health situation publication

Non vaccine-preventable diseases

The main infectious diseases to which travellers may be exposed, and precautions for each, are detailed in the Chapter 5 of the International travel and health situation publication. The most common infectious illness to affect travellers, namely travellers’ diarrhoea, is covered in Chapter 3 of the International travel and health situation publication (WHO). Because travellers’ diarrhoea can be caused by many different foodborne and waterborne infectious agents, for which treatment and precautions are essentially the same, the illness is not included with the specific infectious diseases.

Information on malaria, one of the most important infectious disease threats for travellers, is provided separately (WHO).

The infectious diseases listed below have been selected on the basis of the following criteria:

  • Diseases that have a sufficiently high global or regional prevalence to constitute a significant risk for travellers;
  • Diseases that are severe and life-threatening, even though the risk of exposure may be low for most travellers;
  • Diseases for which the perceived risk may be much greater than the real risk, and which may therefore cause anxiety to travellers;
  • Diseases that involve a public health risk due to transmission of infection to others by the infected traveller.
  • Amoebiasis
  • Angiostrongyliasis
  • Anthrax
  • Brucellosis
  • Chikungunya
  • Coccidioidomycosis
  • Dengue
  • Giardiasis
  • Haemorrhagic fevers
  • Hantavirus diseases
  • Hepatitis C
  • Hepatitis E
  • Histoplasmosis
  • HIV/AIDS and other sexually transmitted infections
  • Legionellosis
  • Leishmaniasis (cutaneous, mucosal and visceral forms)
  • Leptospirosis (including Weil disease)
  • Listeriosis
  • Lyme Borreliosis (Lyme disease)
  • Lymphatic filariasis
  • Malaria
  • Onchocerciasis
  • Plague
  • SARS (Severe Acute Respiratory Syndrome)
  • Schistosomiasis (Bilharziasis)
  • Trypanosomiasis
  • Typhus fever (Epidemic louse-borne typhus)
  • Zoonotic influenza

Some of the diseases included in this chapter, such as brucellosis, HIV/AIDS, leishmaniasis and TB, have prolonged and variable incubation periods. Clinical manifestations of these diseases may appear long after the return from travel, so that the link with the travel destination where the infection was acquired may not be readily apparent.

Special feature

Vaccine-preventable diseases

Vaccine-preventable diseases
  • Cholera
  • Hepatitis A
  • Hepatitis E
  • Japanese encephalitis
  • Meningococcal disease
  • Rabies
  • Tick-borne encephalitis
  • Typhoid fever
  • Yellow fever

Information about available vaccines and indications for their use by travellers is provided in the pdf entitled vaccine-preventable diseases and vaccines beside. Advice concerning the diseases for which vaccination is routinely administered in childhood, i.e. diphtheria, measles, mumps and rubella, pertussis, poliomyelitis and tetanus, and the use of the corresponding vaccines later in life and for travel, is also given in the section Vaccines.

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