Nearly 20% of cancer drugs defective in four African nations
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You'd like to think that companies have factories with quality control laws and there are local people trying to ensure that all of their product are up to the local standards. What you don't expect is that they are binning them like Intel CPUs, where they just make a batch and hope for the best, take cream off the top until the priority orders are done and then everyone else gets whatever is left. You might get a slightly better product sometimes but not be so lucky the next time.
I'm not going to cast stones at this practice because as always the alternative isn't some magical world where all produce is perfect, the real alternative is that it gets thrown in the trash and wasted, and everyone is worse off despite feeling better about themselves.
Depending on what's the minimum quality you consider acceptable for the product, you might want to throw away something and have good reasons to feel good about yourself doing it. There is a point where something dips below good ("less effective medication") and even neutral ("it's an empty pill"), into actively harmful ("it will kill you faster"). Discarding it instead of monetizing it is the positive outcome.
My view is a bit different nowadays, but this is very much an extreme bird's eye view from very high up, looking at only the smaller processes I have no disagreement. So, my point is more like an alternative co-existing higher level view, not a replacement of what you and others say. You will still be right to want to optimize your processes of course.
I view it as different streams. Everything is a circle. There is a significant cost - energy (and time and space and effort). As long as we use ancient sun-energy dug out of the ground it's bad, but if we could power the circles with current sun energy it would not matter much.
You have one overall stream or flow, all materials, and output streams are various sizes of end products. The good stuff stream flows to the customers (and forms bigger circles), the mistakes are instead rerouted into the recycling stream.
In chemical engineering and in manufacturing you have the same. Making food, whether completely natural, or including any kind of processing even if it's just separation and packaging, will have similar properties. Quality varies, and you have additional processing streams for various qualities.
Sure, one would want to optimize the streams, but if we did not have the fossil energy source limitation, and maybe also space, if you have to go back to the growing fields, it would not matter too much.
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Imaginary picture:
Imagine in the far future somebody set up a fully automated closed system for making food, from growing to putting it in a huge cafeteria buffet, fully stocked all day. But there is no more people. As long as there is energy, food is created, processed, put on the buffet, and then recycled, since there is nobody to actually eat anything.
Is it a waste? Well, yes and no.
The whole of earth is like that!
As long as there is energy the cycles continue. What is "waste"? If you take the very big view, everything just "is".
But again, our actual limitation is the energy source for our food cycles. Using ancient stored sun energy releases the carbon stored underground, and it also slowly depletes those stores. The real problem first of all is where we get the energy for our cycles from, not really if parts of it don't make it to the end customers. Opportunity cost, what we could use the space and general effort for instead of on recycling cycles comes a distant second, I think.
Over here in The Netherlands, the milk for all milk products comes out of the same cows and is processed in the same tanks. When you're paying 2x the price for brand name milk, you're getting seriously scammed.
I learned recently that there was a small coop near where I live that got bought up by a larger one, Organic Valley. Which has a semi famous permaculturist as a member (Mark Shepard), and the only reason I knew it to be a coop. They don’t advertise that fact well.
Id like to live in that world.
Some time ago I was very frustrated with the massive swings in how well a prescription was working so I started looking into it. Saved a pill from every month, sent 12 of them off for testing.
+/- 30% accuracy on that dosage, and that's within spec for the US. Some months your 20mg pills are 26mg. Others? 14mg. Later repeated this test with a family member's blood pressure medication, which has a dosage of just 0.5mg. Same deal, 0.35-0.65
Hopefully those countries don't reduce standards due to lobbying.
This is funny because the USA itself doesn't do proper inspections.
https://en.wikipedia.org/wiki/Katherine_Eban
See the book "Bottle of Lies".
You shouldn't be able to sell what is basically sugar water in Somalia and call it cyclophosphamide. That's fraud if I do it as a private citizen.
In fact it's even fraud for me if I buy actual cyclophosphamide, and cut it with a bio compatible totally non reactive filler compound. How are these people getting away with it without the president and senators being on the take? When they'd run you or I down in less than a month for effectively the same act?
To be clear, I don't believe you or I should be able to do this. But I know what happens to private citizens who try to do things of this nature. So there is no question that this is a crime. The only question is why is it not prosecuted for larger corporations.
Here I’ll remind you: nearly 20% of cancer drugs defective in four African nations.
That’s the context. What on earth are you talking about?
>roughly one in six — were found to have incorrect active ingredient levels
>But some drugs are also counterfeit, and that increases the risk of discrepancies between what's on the product label and the actual medicine within.
If I was desperate, and given a choice between either 1 of "Might have incorrect active ingredient levels" "Might be counterfeit" "Might have been stored improperly" or "No cancer drugs for you" I know which way I would be leaning.
"Defective" is doing a lot of work in this headline.
its like everyone learning during covid their neighbors would kill every service worker to avoid the inconvenience of making their own coffee. it leaves a mark.
see what happened to the poor n-gate.com fellow, burned him out
1. "Everything is securities fraud" is a running series showing the breadth and depth of how shareholders exercise their rights in creative ways.
Not the primary reason, but it was part of it.
You can get SNAP (free food), Section 8 (free housing), Medicaid (healthcare, CHIP for kids is easier than adults, but still many people get it), and if you manage to raise smart kids despite poverty they will get college for free as well (most highly-selective universities are free for the poor, but extremely expensive for even the middle class).
I own a lot of rental property and I have a Section 8 tenant who has never worked, completely gamed the system with a subjective disability that renders her unable to ever hold a job (supposedly). A good tenant but is constantly trying to give away tons of food she buys because she always tries to spend the SNAP she gets every month. And she gets free heat, and electricity, and public transportation pass, and on and on.
If you're middle class, that should be the average and that means you only get things which are the foundation of the system covered by the taxes.
These benefits are binary, not tiered, so once you earn a dollar over the incredibly low threshold, they vanish. So the person I know cannot get a job and work, because if they earn over ~$16k in a year all the benefits go away. And where she lives you need about $50k/yr minimum to scrape by. So there is this $34k/yr gap which creates a no-mans land of livelihood.
it also creates/necessitates a vast enforcement bureaucracy to make it all "work" which in itself is a huge waste when you could just tax it back from high-earners at the end of the tax year... its almost as if it was designed to suck
The more useful identifiers would be roughly young and/or working, and old and/or non working. The latter category also covers the beneficiaries of wealthy people (who are among the old and/or non working).
The USA (and many countries, especially democracies) has a situation where your expected quality of life is lower (or not sufficiently higher) for the young and working than the young and non working for those not lucky enough to be born to the right families or prudent enough to make the right choices in school, etc.
The incentives should always be such that expected quality of life is always greater for those working than non working.
Note that this is a different topic than whatever the floor for quality of life should be.
Why would the person who spent 40+ years working have a worse quality of life than someone whose spent 10 years working? The incentives you put up basically say "as soon as you are done we're sending you to the glue factory."
Those are the incentives nature puts up.
>Why would the person who spent 40+ years working have a worse quality of life than someone whose spent 10 years working?
Depends how much they earned and saved. Current workers (proxy for young) know they will not have a quality of life as good as those that have already worked decades past, so where is their incentive?
>because they already (most of the time) spent 40+ years working.
But they (at least these first few generations) are receiving healthcare worth far more than the work they did, tenable only due to the higher total fertility rates of many decades ago.
At its root, these deferred benefit schemes were either never sustainable for modern lifespans and healthcare consumption, or they depended on unrealistically high total fertility rates. One could even say they played a role in causing lower total fertility rates, as society de-coupled raising one's own productive children and having a good quality of life post working age, since you could now depend on others' productive children.
Money, savings, and other wealth abstractions that legislators can easily bring about don't materialize the goods and services one might want to buy.
When I was younger I had an easy time buying into "everything is too expensive to save money", now that I am older, past the "you must start saving now" age, I know way way too many people who don't save for retirement and live stupidly beyond their means.
"We don't have any retirement savings because how could we give up eating out 1-2 times a week, $250 monthly beauty appointments, $90 gym membership (they have clean warm towels!), and our annual Disney vacation and our family Lake Tahoe trip. And no way will you catch me in a 5 yr old used car, sorry I cannot sacrifice my new car leases!"
I know so many more people who recklessly spend money than people who honestly are trying but cannot make it.
It's developed since then in interesting ways and shows up everywhere. The biggest thing is that each cohort looks down on those "beneath" them. This manifests in different ways... people living in public housing, getting housing and typically SNAP benefits, will often scoff at people collecting temporary assistance (cash) as loafers.
If you're looking at families, the prevailing rent in Onondaga County, NY (Syracuse) is $1475 for a two-bedroom apartment. "Prevailing" rent is the metric used for Section 8 is essentially the price floor for an adequate apartment. The median household income in the county is $74,000, which is 23% rent to income ratio, so pretty good, right? (Keep in mind, this is from a not so great apartment that passes Section 8 inspection, but little else) Eh, not really, the well-off suburbs skew the statistic... if you look at the City of Syracuse, more representative of the blue collar working class and poor, the median income is $45,500 -- 39% rent to income. The median household in the city requires some support to live -- in Syracuse that's like 70,000 people
As you see purchasing power decline for working people, traditional "middle class" respectable jobs are falling off the ladder in terms of livability. A parent in a 90% of retail and semi-skilled labor jobs is making $80-90k max, and is basically a car disaster away from financial ruin. Many, many of these people are stuck with non-dischargeable student debt for life as well.
or in this case, why bother putting any effort into life when doing nothing provides a greater reward? why attempt to make something of oneself at the risk of losing everything forever?
all in all, whether or not intentionally curated, these societal facets serve to foment an atmosphere of fear - individuals are forced to exist either in ignorance, or otherwise must live with the knowledge that minor infractions may end one's dreams, while concurrently one's dreams may be ended at any time for no reason but the whim of another.
such a dichotomy between ignorance and fear effectively suppresses societal change, which if it were to happen anyway, would be instantly detected by automated surveillance, and promptly quashed under fully legal pretences. but that's not even necessary. the populace is already addicted to living vicariously through screens (now from birth thanks to parents being forced to devote energy to work instead of their children).
yet the world keeps turning
And funny enough, the poor are just about to loose their healthcare and food stamps via big beautiful bill. Which is official name of that bill.
These companies are making defective drugs and shipping them to people. The only thing preventing that from happening in the United States is the regulatory system, which we are in the process of smashing.
Cancer treatment effectiveness has improved substantially, with many treatments now achieving high cure rates or significantly extending survival.
Highly effective treatments:
Surgery remains the most curative treatment when cancer is localized and can be completely removed. Complete surgical resection often leads to cure for early-stage solid tumors.
Chemotherapy can be curative for several cancers, particularly blood cancers like leukemias and lymphomas. Some testicular cancers and certain pediatric cancers also respond extremely well to chemotherapy alone.
Radiation therapy achieves excellent local control and can be curative, especially when combined with surgery or chemotherapy. It’s particularly effective for head and neck cancers, early-stage lung cancers, and certain brain tumors.
Revolutionary newer treatments:
Immunotherapy has transformed outcomes for melanoma, lung cancer, kidney cancer, and others. Some patients with advanced disease achieve long-term remissions that were previously impossible.
Targeted therapies work exceptionally well when tumors have specific genetic mutations. Examples include imatinib for chronic myeloid leukemia (transforming a fatal disease into a manageable condition) and HER2-targeted drugs for breast cancer.
CAR-T cell therapy has achieved remarkable results in certain blood cancers that failed other treatments, with some patients achieving complete remissions.
Combination approaches:
Modern treatment often combines multiple modalities - surgery plus chemotherapy plus radiation, or immunotherapy plus targeted therapy. These combinations frequently outperform single treatments.
Current limitations:
Some cancers like glioblastoma and pancreatic cancer still have limited treatment options, though research continues. Metastatic disease remains challenging, though increasingly manageable as a chronic condition rather than immediately fatal.
>[...] Those causes can include faults in the manufacturing process or product decay due to poor storage conditions. But some drugs are also counterfeit, and that increases the risk of discrepancies between what's on the product label and the actual medicine within.
So this is actually pretty in line with the top level comment, since no mention of the actual ratio among reasons is made. It certainly doesn't say that counterfeiting and after production storage are the main reasons.
In the UK I know the NHS buys generics, which implies they are effective, but I wonder.
I pay the 2$ it cost for brand name ventolin (my insurance cover the cost generic and I pay the difference) as the generic give asthma attack. But I would not pay one cent more for the brand name Vyvaanse. Effect wise the generic is indistinguishable (but damm the pills colors make them looks like a cheap gray market knock-off).
My wife has a paper from her oncologist for original femara because the generic made her faint a few times ( the insurance cover the whole cost because of that paper)
You also make it sound like 2$ isn't much to go from the generic to brand-name Ventolin. How much is too much? And is there a difference between generics of the same drug (I assume multiple manufacturers can actually produce generics) and how do you know which is better?
Sadly they do not. I got prescribed 12.5 mg tianeptine to take three times a day, except that amount is minuscule for my brain & body. You would think they take into account that I have fast metabolism, have many brain lesions, and so forth, but no, they do not, and there are no legal frameworks either to do so. They would have to account for these lesions in my brain for many reasons, but they do not.
how do you know which is better?
Hopefully, the doctor will account for that when prescribin...
is there a difference between generics of the same drug ?
For stuff like that works on the hormonal system the difference between them is more pronounced. Like the femara, an aromatase inhibitors the block estrogen production, the brand name was significantly better for my wife but reading MBC survivors forums it's not the case for everyone. And reading those forums, it's a problem in place like the UK where the only things available is the brand NHS choosed for you.
How much is too much ?
Note that I have something my pharmacist call a gold-plated drugs insurance. If we were only covered by Québec's public regime, my wife would probably be dead by now as they still do not reimburse Kisquali, it's suppose to change soon but I am not that informed on that because of my gold-plated insurance. (which is fucking stupid because the alternative was weekly in hospital chemotherapy that cost a lot more than 5700 a month, but then people with that treatment doesn't usually live that long so cynically it probably cost less to the system that way even)
Edit:
Why do I know that
I’m on an extended release generic only because it’s older than dirt.
Instead this mostly comes down to how effective each countries regulations are.
My friend the John the Pharmacist explained that the binders etc can accelerate absorption. His advice was be careful the first two days of a new generic formulation.
I would assume the NHS (like the TGA here in Oz) looks _very_ carefully at the side-affect profile before they buy any particular generic. Government agencies tend to try not to poison voters.
Generics are effective
Variance per dose is about plus/minus 15% across the board. You might get 9mg one day, and 11.5mg another for a drug with a nominal 10mg label. Injectables are typically better than oral tablets it seems but not by a lot.
Purity was pretty good though, it was mostly a dosing variance I saw.
It wouldn't work, but when I see appeals to authority (FDA) enter the room, it's usually to feel superior because its a logical fallacy in argument but the place it actually fits (which btw, is here, in this thread) is that compliance to standards and policing them, is not "argument" it's the "you only had one job" part of the gig.
"yes Mr Kennedy, these friends of yours are very nice at parties, but unfortunately they are neither qualified, nor actually capable of fulfilling their role and so no, you won't be appointing them" is what the Bund would do.
Being able to take a compliance body oversight function and leverage it to remove adjuvents because of one paper, despite overwhelming evidence to the contrary, is precisely whats wrong in the current politicised situation.
If people making generic cancer drugs for use in africa had to be held to the standards in the west, we'd all be better off. I have said elsewhere that if the US rejects flu vaccines because of the mercury, they should be checked for other compliance and standards, and subject to cold chain integrity shipped to economies who usually can't afford them, and can use them.
The irony here being that the degree to which Kennedy and Johnson bungled 'nam was in large part a doing of the professionals with their academic attitudes about how foreign policy and war ought to be conducted. Obviously you don't get do-overs with history but it's very possible that Kennedy's preferred cabal of self serving frat bros would have concluded "the Vietnamese are screwed either way but we come out looking better not escalating, dominoes be damned".
>If people making generic cancer drugs for use in africa had to be held to the standards in the west, we'd all be better off.
How can you say that without an understanding of how much it would shrink the market in Africa?
$600 "perfect" insulin vs $50 "good enough" insulin. Metaphorically speaking.
just wanted to point ou his most famous patent, the Einstein-Szilard fridge
(considerably less famous than the Einstein-Szilard letter, so I feel there's another argument for or against technocracy right there)
There was a fascinating article I read years back about how much of China’s top leadership had engineering degrees, unlike in western countries. Then the article pointed out how that led to things like the one-child act based on research in the 1970s predicting mass starvation. That one child policy is now leading to possible demographic collapse after causing decades of social strife.
Be careful what you wish for, as you’re possibly a variable which could optimized out.
Alternatively consider the long term ramifications of leaving pandemic responses purely in the hands of unelected epidemiologists whose primary focus is a virus and not the overall welfare of a population. Those are not the same thing after all, even if they seem like it at first glance.
IMHO, alternative means of thinking are needed in a governmental system for the best overall outcomes.
(he wrote rather bad scifi about talking to dolphins. Somebody else, Pierre Boule wrote it much more sexy/exciting, that became "the day of the dolphin")
https://www.palladiummag.com/2021/03/16/leo-szilards-failed-...
Technocracies tend to be more accountable than cults of personality and even nontechnical intellects (Kissingers) there's that
Bad dolphin sci-fi sounds a bit too much for my tastes. Though it’s often the border line crazy folks who give us some of the best ideas or stories. Though they also often need refinement by, uh, more standard people. I say that as an ADHDer who sometimes benefits from the same.
See more rational for needing mixed viewpoints!
Really the biggest problem with a technocracy is that power corrupts, and that people already refuse to admit when they were wrong because it would be detrimental to themselves. Make the metrics of what is right the key to power, especially with no objective arbiter and you'll see shit pretty much indistinguishable from Lysenkoism. As seen with the Great Leap Forward and its 'immovations' in agriculture, it is a road towards madness, not an accelerated path to progress.
Might makes right and war in general have many, many, many things wrong with them and should not be looked towards as some sort of ideal. But such conflicts forces objective verification of the technologies, tactics, and strategies and force science to be real to succeed. You cannot rely upon Lysenkoism to feed your armies because it is not real. If you insist that bullets cannot harm you because of your breathing techniques even if you convinced others of your bullshit it won't save you from a gun. But conversely if you insist you are protected from bullets by the right ceramics and kevlar even those who sneer at you for "using pottery for armor" if it blocks bullets and absorbs kinetic force it is right and thus "scientific" in a way.
Today, most of the Cabinet positions are held by people who love to talk, who are generally extremely wealthy and/or well connected, and who are generally unqualified for their jobs. And, even more relevantly, they have been very heavily interfering in the operation of their respective departments.
The numbers seems roughly proportional to US opioid deaths (though I haven’t taken a detailed look, and there may be differences in the way deaths are categorized): https://nida.nih.gov/research-topics/trends-statistics/overd...
Australia wont import FDA certified beef. For great reason.
Australia doesn’t allow most USDA beef because of strict biosecurity rules.
Australia’s one of the world’s biggest beef exporters. There’s not much incentive for them to open the door to a competitor unless the protocols align perfectly.